“As human beings, the most important factor for our survival has been supportive relationships” – Patricia Jennings (AFT 2019)
In recent years, ‘Trauma Informed Care’ has become a ‘buzz phrase’ in the human services field, including the clinical practice of Applied Behavior Analysis (ABA). Some have attempted to learn more about what it means for their practice and consumers, others have advocated for more training, research and collaboration regarding trauma informed care, and there were many who gave little thought to how this could and should affect their work.
I didn’t need the BACB (Behavior Analyst Certification Board), a supervisor, or insurance company to tell me that trauma-informed care was critical to my work and to my practice as a BCBA (Board Certified Behavior Analyst) overseeing and implementing clinical programming for individuals with autism and other developmental disabilities. Still, without an explicit background in Trauma Informed Care, there were questions I needed to ask myself and seek answers:
‘What does the term trauma-informed care mean?’
‘What does using it in my practice look like for me?’
‘What does it look like for the clients that I serve?’
‘What does it look like for the eager minds that I mentor and supervise?’
These questions and many others circling my mind prompted me to look beyond myself, beyond my supervisors, and really seek to find greater skill and knowledge in approaching those that I served in a way that was compassionate and had trauma-informed care at the forefront. What I found was life changing – not only for me, but for all those I came into contact with.
As human beings, we seek to build strong, trusting, compassionate, and lasting relationships with other humans – it is imperative for how we thrive, grow, develop, and navigate life’s circumstances. However, those who have experienced sources of trauma, abuse, neglect, or exploitation in their lives – especially during childhood – often struggle with the ability to develop and maintain strong, safe, and healthy bonds with others. The effects of trauma will often manifest into displays of challenging behaviors and sometimes subsequent diagnoses of addiction, mental health disorders, or disabilities. Dr. Jeannie Golden reminds us that challenging behaviors are often masks that hide trauma – if they can’t tell us what is wrong, they will act it out (FABA 2023).
When reading and learning about what a trauma-informed approach looks like, I saw many repeated ideas and suggestions along with many researched techniques and approaches.
First, I learned that pairing, or building a rapport with the individual was key – we should seek to gain trust. We want the individuals we are serving to want to be around us, to want to engage with us. Second, I was reminded that I needed to have, maintain and continue to exercise cultural competence, not only the culture of the individual I was serving, but also the culture of their support systems as they could be very different. Next, I learned that a trauma-informed approach looks different for everyone – there was not one singular tactic or action that would successful for everyone: it took individualizing my approach to the needs of the individual I was serving – and that identifying their individual approach was my responsibility. As a BCBA, my clinical training helped me cover the basics of identifying appropriate tactics – review historical data, speak to people familiar with the individual, speak to the individual themselves, identify reinforcers (more on this later), identify environmental or behavior antecedents, identify functions of their behavior, and so forth. Perhaps most importantly, I learned that I needed to be sure that I was taking care of myself. It is often said that ‘you can’t pour from an empty cup’ and while this is so true, it is even more imperative when working with individuals who have a history of trauma or abuse. Learning other people’s histories of abuse or trauma can be difficult, and if I lacked the skills to keep myself healthy I would not be able to support those that needed my support the most. We also need to be aware of our own histories, as we ourselves can be triggered if we have experienced abuse or trauma in our past.
Although I no longer practice as a BCBA in the capacity that I was, I look back and see the difference in which taking a trauma-informed approach bettered the lives of those that I served. I spent about 1.5 years working with adults in a group home setting; it was here that I witnessed many displays of challenging behavior that went well beyond the current circumstances or environment – behaviors that were displayed as a potential result of previous trauma or abuse. I worked with individuals who were able to vocally tell me about their histories, others I read in previous reports or discussions with other staff, some I learned about by reading police reports/arrest records and others who were only able to tell me of their abuse by ‘acting it out’ as Dr. Golden mentioned. Often, I would never know the exact instances of trauma or abuse the individuals endured. Each case was uniquely theirs, and each required a delicate, deliberate, and thoughtful approach.
It is so important to remember that this is just how I approached the situation I was in at the time. There are so many resources available for different settings we may find ourselves working in, and seeking out those specific resources should be our top priority as service providers. In that specific environment, I did not have quick access to a mentor or supervisor who was able to be present in the moment to provide coaching, so I used the resources I had in a capacity that was achievable to me.
My first priority whenever interacting with a new individual in my adult group homes was to build a relationship from a foundation of trust; I did this through pairing, or “rapport building.” For example, I made sure to call each of my individuals by their preferred name, and I asked their permission to spend 1:1 time with them and engage in their preferred activities; sometimes that meant sitting quietly in a room, other times it meant watching true crime shows, and sometimes that meant learning to play a video game I had no business learning. At the end of my time with that individual, I would always thank them for letting me be there and remind them I was there to help them. Over time, as rapport was built, many of the individuals in the group homes began to approach me, ask to spend time with me, and note on their calendars when I would be back so they could plan an activity for us to do together.
As I was building rapport, I was gathering as much information as I could for the individuals, and working through their current plans of care to ensure that not only myself, but the staff, were approaching behaviors and skills in ways that would benefit the individual’s growth. I learned what the individual identified as important to them, and did my best to ensure they were fulfilled with the skills we were working towards. I was careful to observe, note, and learn more about the culture of not only the individuals I was serving but also their caregivers, guardians, and group home staff. Arguably one of the most difficult challenges I faced in ensuring a trauma-informed approach was working with the staff to take on the same mindset. I did a lot of modeling of appropriate interventions, attempted to build rapport with the staff, provided frequent praise, advocated for their well-being to my superiors, and ensured that each training I conducted for my staff was robust in new skills (both self-care skills and skills to be used with our individuals), resources, and opportunities for pairing. I learned through the pairing process that some of my staff were experiencing their own traumas or working through some of their own histories of trauma and/or abuse. This taught me that not only did I need to work with my individuals using a trauma-informed approach, but also the staff I was working with. This took a whole other skill set to build – but I won’t get into it now.
I would love to say that each and every one of the staff I worked with was able to implement the skills I taught and take advantage of the resources I shared, but I can’t. Instead, what I can say is that for some of the staff, definitely less than half – it worked, and while I wished for more, I would take what I could get. I was able to see some of our staff using more trauma-informed approaches, attempting to build rapport, and seeking more information on histories of the individuals they served. I was able to build relationships with the individuals I served, assist in helping them build coping skills, reduce challenging behaviors, and advocate for their needs and wants. For the time that I was in their lives, I know that I was able to serve their needs with a trauma-informed approach.
As BCBAs, we place a lot of emphasis on function: function-based interventions, functions maintaining challenging behaviors, and functional communication. Identifying the function of a behavior allows for identifying alternative skills or behaviors to teach. When discussing functions of behavior, we have what are commonly referred to as ‘the four functions of behavior’ or ‘the big four’ which are Attention, Automatic, Access/Tangible, and Escape/Avoidance. There has also been talk of a fifth function that has been discussed in some capacity among BCBA’s, but one that is often overlooked or left out of important and critical discussions called Signs of Damage. It is best summarized by stating that the sight of damage to another human or object(s) may be what is reinforcing to the individual. B.F. Skinner first addresses this in work titled Contingencies of Reinforcement. Dr. Sharon Older suggested that signs of damage is a learned reinforcer. In her words “Hurt people hurt people…When you are in pain, it creates a reinforcer for creating pain in others…and traumatized kids have a lot of pain” (FABA 2023). I would go so far as to say that individuals with histories of trauma or abuse most often are the ones learning this as a reinforcer; they are experiencing escalated situations, not armed with appropriate (or any) coping skills, and potentially observing others in their life being unable to manage their own emotions in appropriate or safe ways. It is our duty, as practitioners, to help those we serve learn replacement behaviors and skills that will help them to manage their emotions in different ways. We can do this in a variety of ways, some of which include leaning into their current reinforcers, identifying safe ways for their reinforcers to be received while also helping them to identify and establish different reinforcers and alternative behaviors or skills to get their needs met.
Trauma informed care necessitates an individualized approach. Here are my individual take-aways from my experiences learning about and using a trauma-informed approach.
- What does the term trauma-informed care mean?
Trauma-informed care means that I am seeking to approach each of the individuals I serve in a way that utilizes a whole-person approach; understanding their histories of reinforcement, understanding (to the best of my abilities and knowledge) their personal history, culture, and events. - What does using it in my practice look like for me?
To me, trauma-informed care means that I am seeking to approach and work with those that I serve in a way that best suits their specific needs. It means that I am seeking out information regarding individual histories, identifying current reinforcers, and current coping skills used. It means that I am meeting those I serve where they are at, and helping them to gain access to skills that will get their needs met in ways that are culturally appropriate and socially valuable to them and their environments. - What does it look like for the clients I serve?
It looks like my clients are getting the best possible care, building a meaningful relationship with myself and those who participate in their care. For some, it may mean experiencing a safe place for the first time. - What does it look like for the eager minds that I mentor and supervise?
This approach means that those I mentor and supervise are gaining insight and skills to use this approach with their future individuals and practice. It means that I am seeking to build the same relationships and use the same skills with those that I mentor and supervise in such a way that can address traumas or abuse they have in their history. It means that those I mentor and supervise are learning they have a safe space with me and learning skills to engage in self-care and self-love.
To close, I want to encourage everyone to explore how you can better apply a trauma-informed approach to your practice in whatever capacity that may be.The above are questions I asked myself and found to be helpful in guiding my learning process. I hope they can be helpful for others, as well.
Special thanks to Andrea Zuchora M.S., BCBA for editing and providing many useful suggestions!
About the author
Ashley J. Moss
Ashley graduated with her bachelors from Penn State University in Rehabilitation and Human Services. She obtained her masters in Applied Behavior Analysis from Florida Institute of Technology in 2019. Ashley has provided care in a variety of settings using Applied Behavior Analysis including group homes, clinics, schools, and family homes. Currently, Ashley lives in Florida. In her free time she enjoys reading, visiting various theme parks, and traveling.
Sources:
Golden, J., Older, S., Zajac, S., & Flannigan , A. (2023, October). Come with Alice Beyond the Looking Glass: Trauma-Informed Strategies for Challenging Behaviors
Jennings, P. A. (2019). Teaching in A Trauma-Sensitive Classroom: What Educators Can Do To Support Students
Skinner, B. F. (1969). Contingencies of reinforcement : a theoretical analysis. Appleton Century Crofts.