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| Trauma Informed Care: Through the Lens of Applied Behavior Analysis |
| Sunday, May 28, 2017 |
| 5:00 PM–5:50 PM |
| Hyatt Regency, Capitol Ballroom 4 |
| Area: CBM/DDA; Domain: Translational |
| Chair: David Donnelly (University of Rochester) |
| CE Instructor: David Donnelly, Ph.D. |
| Abstract: Within the medical and psycho-social therapeutic communities, there has been a growing awareness that exposure to traumatic events can have a significant impact on the person so exposed. As a result, there has been a growing literature calling for and describing approaches labeled as Trauma Informed Care (TIC). Considerable journal space and federal funds have been dedicated to TIC, and reports of effective treatment have multiplied as well. As with many new ways of conceptualizing and treating problems, there has been much excitement regarding this as a way of improving therapist sensitivity and therapeutic outcomes. The rapid expansion and variety of methods claiming to be TIC has resulted in a field that lacks cohesion, as well calling into question validity of the claims made.
The purpose of this symposium will be to discuss the concept of trauma from a behavior analytic perspective, to explore the existing TIC literature through the lens of applied behavior analysis (ABA), and to highlight where a behavioral approach can be used to better define, understand, and effectively treat individuals who have experienced trauma. It will be suggested that TIC would benefit substantially from ABA conceptualization, methods, and outcome measures. |
| Instruction Level: Intermediate |
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| Trauma-Informed Care: Operationally Defining Trauma |
| (Theory) |
| KEITH FREDERICK GORDON (University of Rochester / Hillside Family of Agencies), David Donnelly (University of Rochester) |
| Abstract: The term “trauma” has become ubiquitous (both amongst mental health service providers as well as the general public) when describing adverse past events and their effect on the behavior of individuals. Correspondingly, service providers across multiple disciplines have been tasked with providing “Trauma-Informed Care” to consumers. While operational definitions of trauma have been generally lacking, it has been described as asking “what happened to you?” instead of “what’s wrong with you?” With its emphasis on ontogeny and the lawful, deterministic nature of behavior, Applied Behavior Analysis is fundamentally oriented towards providing service consistent with this ideal. By defining trauma and its behavioral effects in precise scientific terms, ABA researchers can open a path towards invaluable contributions to the existing body of research. It is also imperative that ABA practitioners bring this precision to interdisciplinary treatment teams serving trauma affected individuals. Dialectical Behavior Therapy’s teaching and differential reinforcement of incompatible and alternative behaviors (“Distress Tolerance Skills”) is one example of a well-established treatment in use by other disciplines where collaboration from a behavior analyst is clearly therapeutically indicated. |
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| Evidence Based Treatment of Trauma-Informed Care: A Review of the Literature |
| (Theory) |
| KELLY POSTLE (University of Rochester; Stepping Stones Learning Center; NYSABA;), David Donnelly (University of Rochester) |
| Abstract: Patients with a history of single or multiple traumatic life events who utilize health care or social services may become re-traumatized or experience distress during these interactions. Direct service professionals can eliminate or reduce these episodes through trauma informed care (TIC) that is person-centered and unique to specific person’s needs. Despite the growing professional awareness and need to incorporate TIC into practice, few research studies have examined successful care implementation or outcomes within these vulnerable populations using a behavioral approach in conjunction with patient reported outcomes. The literature focusing on providing TIC across practice settings over the past three years was reviewed, focusing on objective measures of behavior change for the person that had experienced trauma. Results suggest that most of the current literature does not provide sufficient information to be considered evidence-based. Recommendations regarding possible contributions from Applied Behavior Analysis will be included. |
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| Trauma-Informed Care: Trauma as Establishing Operation? |
| (Theory) |
| MEGHAN L. MCGEE (University of Rochester Warner School of Education), David Donnelly (University of Rochester) |
| Abstract: The co-occurrence of a mental health illness in individuals with an intellectual disability is approximately 3 to 5 times greater than those without a disability. Research studies and other prevalence data indicate findings of a significant range, 20% to 71% respectively. Further, individuals with a developmental disability demonstrate a higher rate of problem behavior than those without a disability or mental health need.
Baker & Blumberg (2006) positioned “an underlying psychiatric disorder can be seen as an establishing operation” when engaging in a functional behavior assessment: the process to investigate the environmental influences and reinforcement on problem behavior. The establishing operation informs the likelihood of target problem behavior by altering the reinforcing (and punishing) value of the consequences immediately following the behavior. The purposes of this paper will be to investigate a similar position with a specific establishing operation, trauma. A preliminary review of the behavioral literature has yielded no empirically valid studies investigating trauma as an establishing operation independent of developmental disability or in its co-occurrence. |
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