Our Thoughts on Trauma-Informed Care
What does trauma look like to you? Is it something you think you have experienced? I think many of us often think of trauma as major events, or something that caused us physical harm, or being the witness of someone else’s physical harm. I know that is how I had looked at trauma prior to learning more, studying, exploring, and working through my own experiences.
When we think about trauma and ABA, there is a history, in my opinion, that could use some more exploring. Many voices have expressed how they have felt abused by ABA, and their voices are loud on social media and throughout the neurodivergent community. As someone who has been a part of behavior intervention plans that have made me feel uncomfortable, I have to say that I can see why. As a BCBA®, I think we should listen.
When talking about Trauma-Informed Care with some colleagues, I will get some that are genuinely excited and feel empowered and then those who think it is a buzz word or mentalistic, or even met with an eye roll. I have also been that clinician who has thought that I was a Trauma-Informed Care provider, but I was still using Extinction frequently. Extinction is often used as the first resort instead of the last resort, in my opinion and experience. But the rationalization to use it is often well-intended. I have, in the past, had “using a coping skill” as an alternative to the problem behavior that would then be reinforced, and with the best of intentions. I could not figure out why two things were happening: my clients were not spontaneously taking deep breaths when they were frustrated (shocking, I know!), and their “extinction bursts” were not decreasing.
It wasn’t until I had had several lightning bolt moments before I finally made the adjustments to how I respond (and how I train my staff to respond) to problem behavior. During my fieldwork, I observed a young adolescent kid being restrained often. I had a moment then when I realized, this isn’t working and it seems really traumatizing. In clinical practice, I sat through hours long Extinction bursts during which the kids would be crying and screaming, disrobing, or soiling themselves. I would leave feeling defeated and not good about what had happened. I often reflected about what could have done differently that wasn’t going to “reinforce” the problem behavior. It wasn’t good enough for me. I kept studying, delving into the 7 Steps of Instructional Control (7-Steps of Instructional Control) and sourcing trainings that could help me.
What I found was that “compliance” is a trigger word for me, and that I’m not alone. Sure, I want my kids to listen and follow directions, but that is different – that adds value to their lives. I want my kids and clients to be able to show respect for others and their environment, but I also do not believe that can be taught through compliance (or coercion) training. I find that trivial rewards like stickers and treats do not provide lasting change but will leave lasting debris inside of the carseat.
It was a difficult change to start thinking about putting the client first and actually a part of the assessment and treatment planning process, but it is something that I wish I would have embraced sooner. I often start with the questions first: “What do you want to learn,” or “What do you want to be able to do,” or “What do you want me to help you with?” If it is a client who has a different way of communicating, I may present different options or choices. I may show video examples of what we could do, or how we could help. I help with safety goals if that is a concern, and I provide a rationalization as to why we are working on certain safety goals. We incorporate ACT (Acceptance and Commitment Therapy) in all of our sessions, and we try to ensure that the clients’ values are at the forefront of programming. It is not always easy, and can be frustrating when you just want your kid to take a bite of a pizza roll, but if you can continue to listen and respond to the client’s voice, you will eventually get there. Our job is to model calm as a behavior and provide a safe environment to allow for the behaviors that we want to happen to occur freely. And just as we assess our clients’ progress, we need to assess our own behaviors and progress from a place of value and actions that help us walk what we talk.
Across Environments is currently accepting daytime clients who are looking for a person-centered and value-based approach to ABA and challenging behaviors. We work with caregivers by helping to explore new ways to set up the environment and how to respond to behaviors so that, as a family, positive changes may occur. For inquiries, please contact scheduling@acrossenvironments.com.