Association for Behavior Analysis International

Trauma-informed care (TIC) can be defined as a proactive, universal approach—taken by practitioners and organizations—to appropriately support and avoid re-traumatizing individuals who may have experienced trauma. Researchers and clinicians from various human service disciplines have articulated commitments of TIC and argued for their adoption into service delivery models. Although rationales provided in such arguments seem relevant to applied behavior analysis (ABA), discussions surrounding TIC have only recently taken shape in the ABA literature, and an evidence base and technology for practical application of TIC has not been adequately developed. In this symposium, we progress toward bridging this divide by: (a) defining trauma-informed care; (b) describing a rationale and framework for its incorporation into behavior-analytic research and practice; (c) detailing multiple examples of TIC in ABA research and practice; and (d) providing preliminary empirical data on the effects of trauma-informed procedures on socially important behaviors purported to be relevant to trauma. In recognizing the importance of a robust evidence base to the adoption of potentially novel procedures (and the current paucity thereof), presenters in this symposium will share survey, clinical-case, and experimental data in an attempt to illustrate what TIC in ABA research and practice might look like.

The target audience for this CE event includes any behavior analysts who conduct research or practice in service of addressing behavioral challenges exhibited by individuals with and without intellectual/developmental disabilities, and is particularly relevant for those who provide care to individuals who have experienced trauma. Content is designed to be consumable to beginning behavior analysts, although certain intermediate topics (e.g., a behavior-analytic conceptualization of trauma) will be discussed.

Trauma-informed care, although widely recognized for its importance to human services, has yet to fully integrate into applied behavior analysis. Rajaraman et al. (2021) described what that integration could look like on a universal scale. In this presentation, we discuss what a model might look like when applied to the assessment and treatment of food selectivity. Food selectivity is a pervasive problem and affects up to 45% and 80% of individuals with and without disabilities, respectively. Food selectivity and mealtime problem behavior have primarily been treated through differential reinforcement and various forms of escape extinction. Escape extinction, while efficacious, may result in increased aggression, gagging, or vomiting and, therefore, may not be feasible to implement under some conditions. Through various case examples, we discuss a model, consistent with the commitments of trauma-informed care, in which mealtime problem behavior was assessed and treated without evoking severe problem behavior or emotional responding. Treatment components included multiple choice-making opportunities, including the opportunity for participants to participate or leave the treatment context at any point. Treatment sessions consisted of children self-feeding with no physical prompting or physical management on the part of the therapist. Implications for practitioners and future research will be discussed.

Ensuring safety and trust when providing therapeutic services is a core commitment of trauma-informed care. This commitment has implications for the assessment and treatment of dangerous problem behavior in that different approaches to intervening upon problem behavior may be associated with differential levels of experienced safety and perceived trust. One example of a potential violation of perceived trust pertains to the physical management of individuals exhibiting problem behavior. During this presentation, after providing a behavior-analytic conceptualization of the constructs of safety and trust, we share findings from a survey that returned 716 responses, from behavior analysts across the United States, regarding their experiences and opinions on the use of physical management procedures in ABA practice. Findings suggest that there are varied opinions regarding the safety and feasibility of such procedures, with a majority advocating for reduced use in everyday practice. We connect these findings to an evaluation of a systematic replication of the enhanced choice model of skill-based treatment—initially described by Rajaraman et al. (2021)—that importantly avoids the use of physical management, and that was delivered via telehealth consultation. Survey and single-subject data are discussed in the context of exploring trauma-informed processes for addressing dangerous problem behavior.

Children and adolescents who have experienced substantial abuse and neglect typically require input from a range of professionals to support effective assessment and intervention. Unfortunately, behavior analysts have not always been considered key players on those multidisciplinary teams. Although there may be many reasons for that, in our experience, one prevalent concern is that behavior analytic approaches are unsuitable for children who have experienced traumatic events. In this presentation, we will describe how behavior analysis has been integrated into treatment delivery models for supporting a range of children and young people who have experienced substantial abuse and neglect. Through the presentation of data-based case studies, we will describe how behavior-analytic strategies were selected and applied based on the client’s unique trauma histories, as well as the adaptations we made to ensure the strategies were trauma-informed, client-centered, and capable of being maintained in the clients’ homes. We also will describe some of the challenges in integrating behavior analysis into social services in the United Kingdom, as well as suggesting specific strategies for overcoming those obstacles.