ABA PROCEDURES CONSISTENT WITH TRAUMAINFORMED CARE IN MOST CONTEXTS These interventions in particular create an environment that increases client engagement in pro-social behaviors without the use of physical force or what might be considered forced-choice. Procedure How is this traumainformed? Applied Example Noncontingent Reinforcement (NCR) NCR addresses motivating operations by proactively delivering the reinforcer Providing frequent scheduled breaks to a person who resists participating in a dental cleaning (Allen and Wallace, 2013) Measures preference for stimuli that may be provided to decrease rates of automatically-reinforced behavior (NCR , but with continuous access). Competing stimulus assessment (CSA) Differential reinforcement of alternative behavior (DRA) In a review of published research, Gover, et al. (2018) found that environmental enrichment was effective at reducing rates of automatically-reinforced SIB in 45% of cases reviewed. This is a general category of procedures that includes both FCT and concurrent choice, described below. DRA contrasts problem behaviors with desired behaviors such that desired behaviors are favored by reinforcement delivery Providing headphones with music to individuals who engage in vocal stereotypy (Gibbs et al., 2018). Teaching how to ask for a break as an alternative to engaging in aggression to escape work tasks Procedure How is this traumainformed? Applied Example Functional communication training (FCT) An application of DRA, the individual is empowered with a new skill for obtaining what is desired Teaching a learner to tap a friend and wave for attention rather than hit them Demands fading Gradual introduction of lesspreferred activities gives the learner an opportunity to acclimate at a slower pace When adjusting to a change, the change may be introduced in stages. For example, when a child enters a new school she may start with observing the classroom and then is gradually engaged in the activities, beginning with more preferred activities and then introducing more difficult lessons after some time. Concurrent choice An application of DRA, concurrent choice provides two options and manipulates the parameters of reinforcement quality, magnitude, and immediacy (see Kunnavatana, et al. (2018) for assessing client preferences for reinforcement parameters) Aggression resulted in a 10second break from instruction and compliance with demands resulted in a 30-second break from instruction Athens and Vollmer (2010) Incidental/naturalistic teaching procedures Utilizes an individual's interests as opportunities to teach; lessons are generally more meaningful to learners Placing items in view but out of reach to create opportunities to mand Behavioral skills training (BST) A proactive approach that promotes independence Teaching how to respond to a threat, such as a peer who is bullying Procedure How is this traumainformed? Applied Example Social skills training Provides the individual with skills to become more connected with others Teaching conversation skills so that individuals may engage others (see Peters and Thompson, 2015). ABA PROCEDURES THAT ARE GENERALLY NOT CONSISTENT WITH A TRAUMA-INFORMED APPROACH These procedures are sometimes necessary. However, these procedures are typically not considered until less restrictive procedures are demonstrated to be ineffective or otherwise ruled-out by the circumstances. Procedure Why is it included? Applied example Escape extinction Requires holding a client in place until a contingency is met; presents a risk for behavioral escalations to crisis Hand-over-hand cleaning up toys when a learner is already capable of cleaning up toys but is refusing Punishment Controls behavior with aversives and removal of preferred activities; promotes disengagement; damages rapport; ultimately forces suppression rather than a learner making a choice to engage in an alternative behavior Time-out for aggressive behaviors that functions to obtain attention - the learner is communicating a desire for attention and is then further frustrated by being removed from others Using taste aversives to stop finger mouthing - the learner's own body is being controlled; desire for oral stimulation is not addressed Procedure Why is it included? Applied example Negative reinforcement The client is motivated to escape, which conflicts with promoting an environment that is engaging and encouraging connection with others Providing breaks contingent on completion of work tasks is less effective than providing positive reinforcement for completed tasks (Slocum & Vollmer, 2015) These procedures do not allow the learner control over his/her own body Response interruption and redirection (RIRD) is used to address self-stimulation behaviors, such as vocal stereotypy (see Gibbs et al., 2018). Physically restrictive procedures A Difference in Presentation An intervention might easily be flipped from more-restrictive to less-restrictive in the way it is presented. Here are some examples: ________ Negative punishment: “You didn’t finish your chores so I need to take away screen time.” Positive reinforcement: “How about you put those clothes away and we can put on your show.” ________ Escape extinction: “You can get up from the table after you complete this trial.” Concurrent choice with FCT: A 10-s break is provided for escape and a 60-s break with music and dancing is provided for task completion. ________ Positive punishment: Hand-flapping results in response interruption and redirection which requires the therapist to move the client’s hands to his lap and deliver commands until 3 consecutive successes are achieved. Enriched environment: The stimuli from the competing stimulus assessment are provided continuously during work and lower rates of hand flapping. Format for Addressing Triggers When a trigger is identified, it may be addressed using some simple techniques that can combine easily with other protocols. Just like with the analysis of triggers, the treatment works with both operant and respondent behaviors. The treatment approach is indicated for conditioned stimuli as well as a way to modify stimulus discrimination in operant relationships. The steps presented below are based on the booklet How to Teach Self-Control Through Trigger Analysis (Roldier & Axelrod, 2000) and are adapted for trauma use. TEMPORARY REMOVAL OF TRIGGERS When triggers are removed or minimized, a safer and more positive environment is created for the client. This is an opportunity to repair rapport with staff and reinforce prosocial behaviors. Skills training may be conducted at this time to increase engagement with the environment and others. This positive environment provides reprieve from problem behaviors and behavioral momentum for reintroduction of the triggers later. ECOLOGICAL CHANGES Are there other experts to consult, such as the occupational therapist, counselor, or social worker who might provide some options for making daily life with triggers easier? A change could be as simple as a schedule change or as involved as a change in classroom or residence. TRIGGER WARNINGS Advance preparation of trigger presentations can make coping with them easier. A warning of when the trigger is coming A reminder of how the individual can respond A reminder of positive consequences for alternative behaviors TRAINING STAFF & CAREGIVERS Training topics include acknowledging triggers, identification of precursor behaviors, responding to precursors, and how to proceed when behavior escalates. Staff and caregivers should also provide reinforcement for alternative behaviors and be trained to adjust the amount of trigger exposure, lessening it when problem behaviors occur. GRADUAL INTRODUCTION OF TRIGGERS Introduce the triggers gradually by manipulating dimensions such as trigger rate, intensity, and duration. Another option for more generalized triggers, such as a person who is afraid of all people of a certain gender or age, is pairing. The triggering person-type may be paired with trusted people and reinforcing events.
