Trauma Informed ABA

Mahshid Ghaemmaghami Author

04/13/2022 Added

24 Plays

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Conference 2022

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[00:00:09.710]Thank you and good morning.
[00:00:11.940]Thank you for inviting me. I'm really excited to be here.
[00:00:14.340]And yes, that drive was crazy.
[00:00:15.930]I thought maybe I'm just not used to driving in the wind.
[00:00:19.340]And I was telling my husband about it
[00:00:21.410]and he thought I was making it up.
[00:00:22.640]And then, I texted him this morning.
[00:00:24.050]I said, no, it was not normal.
[00:00:25.850]It wasn't just me being a baby, okay.
[00:00:29.470]So, thanks for having me.
[00:00:31.420]I'm really excited to talk to you guys.
[00:00:35.030]And this is my first, I think, in-person conference
[00:00:37.660]since the pandemic.
[00:00:38.957]I'm also a mom of two
[00:00:40.890]and I sit in front of the Zoom screen
[00:00:45.780]all day.
[00:00:46.613]So, I have high heels on but they may come off.
[00:00:49.260]This is gonna be a long day.
[00:00:50.870]All of that to say.
[00:00:53.540]Well, thank you for being here.
[00:00:56.330]What I was hoping to talk to you guys about
[00:00:58.160]and I know that we have a mixed audience, which is awesome.
[00:01:00.970]Some of you are behavior analysts like me
[00:01:03.010]and have been doing this for a while.
[00:01:04.670]And some of you maybe don't know anything
[00:01:07.590]about behavior analysis.
[00:01:08.520]And some of you maybe have a not a very good taste
[00:01:11.080]in your mouth about behavior analysis.
[00:01:12.447]And I appreciate that and I know that.
[00:01:15.260]And part of today's talk will be about the growth
[00:01:20.260]and the lessons that we've learned as behavior analysts
[00:01:23.050]and as professionals that have worked
[00:01:24.360]with kids and families.
[00:01:25.810]And I'm now a mom,
[00:01:27.130]so sometimes I look back
[00:01:28.930]at some of the recommendations I made
[00:01:30.410]and I kind of wanna go back and write a letter of apology
[00:01:33.280]to all the mothers and fathers that I handed those to.
[00:01:37.120]So, part of this will be focusing on the next chapter.
[00:01:41.400]Celebrating things that we have accomplished
[00:01:44.530]and also taking note of things that we did not accomplish
[00:01:48.980]or things that really need to change.
[00:01:50.480]And listening to the consumers,
[00:01:52.520]those that have received our services,
[00:01:54.530]and adjust what we're doing,
[00:01:56.570]respond to those, the feedback that we've received.
[00:02:00.640]So I am inviting you to one, give us another chance.
[00:02:05.020]Come with us on this journey.
[00:02:06.240]And if you are a professional in the field
[00:02:07.890]that is a behavior analyst,
[00:02:09.640]maybe consider some changes to your practice
[00:02:12.640]if you haven't already done so.
[00:02:13.790]So, I really appreciate this opportunity.
[00:02:18.297](inaudible) PowerPoint.
[00:02:22.810]I'm gonna be trying to do this in two ways.
[00:02:26.680]So, I apologize for maybe a little bit of delay
[00:02:31.910]in some of the slides.
[00:02:38.150]Okay, so I'm now a Clinical Director
[00:02:40.540]at FTF Behavioral Consulting.
[00:02:43.470]We are a consulting firm
[00:02:44.510]and we work with a lot of professionals, clinicians
[00:02:47.800]on the ground who are working with kids and adults,
[00:02:51.440]with or without developmental disabilities or ASD.
[00:02:55.020]So, a lot of the work that I do now really
[00:02:57.480]is about implementation of our procedures
[00:03:00.230]in typical settings,
[00:03:01.600]in classrooms, in living rooms,
[00:03:04.690]in the home and relevant context
[00:03:06.930]that some of these behaviors are being emitted
[00:03:10.780]and some of these expectations are placed.
[00:03:12.570]So obviously, that plus the pandemic
[00:03:16.040]and doing a lot of these things
[00:03:18.100]through parents implementation, and teacher implementation,
[00:03:21.560]and professional aid implementation
[00:03:24.020]has really taught us a lot of things.
[00:03:25.950]And it sort of has changed
[00:03:28.890]our practice and process even more.
[00:03:32.520]I do wanna maybe focus on some takeaways first.
[00:03:36.000]So, these are the things I'm hoping to walk away
[00:03:38.370]from this talk with.
[00:03:44.790]Let's start with some understandings.
[00:03:46.870]And one of the takeaway points
[00:03:49.230]is that autism or ASD
[00:03:52.500]does not have to lead to a restrictive lifestyle,
[00:03:56.730]to a lifestyle that is marked by isolation
[00:04:00.130]and limited community involvement,
[00:04:02.780]for the autistic individual or for their families.
[00:04:09.600]Severe problem behavior, however, does.
[00:04:12.910]So, oftentimes, maybe we associate the two together
[00:04:17.330]and we think that is a lifestyle.
[00:04:19.340]And that is something that is going to be present
[00:04:21.650]all the time.
[00:04:22.483]But really, the key variable here seems to be the presence
[00:04:25.990]and the management of severe problem behavior,
[00:04:27.860]the extent to which the individual
[00:04:30.070]can participate in communities.
[00:04:33.310]Now, it's understandable why we have this maybe confusion
[00:04:37.600]because there is a high prevalence of problem behavior,
[00:04:41.970]in particular self-injury, aggression, and severe meltdowns
[00:04:45.670]in individuals with ASD.
[00:04:49.230]And this seems to be higher
[00:04:50.910]than other developmental disabilities.
[00:05:02.980]And so, the question is why is this problem still present?
[00:05:06.700]Especially as someone who's worked
[00:05:08.240]with many families for over 10 years
[00:05:10.520]and my colleagues that I've worked
[00:05:12.150]with many families for over 20 years.
[00:05:14.620]And sometimes we worked with the same families
[00:05:16.340]and the same individual for a long time.
[00:05:18.580]And so when we see these behaviors,
[00:05:21.790]children that we're engaging in problem behavior
[00:05:24.180]continue to engage in problem behavior when they're older,
[00:05:27.280]when they're adolescents and adults,
[00:05:28.720]and the problems seem to get worse and not better.
[00:05:32.060]And this is despite the fact
[00:05:33.930]that we have perhaps offered many solutions
[00:05:36.547]and have tried to help quite a bit.
[00:05:41.840]Now, there are many reasons why problem behaviors occur
[00:05:44.580]and this is, of course, not the fault of the individual
[00:05:46.980]or their families who are basically surviving
[00:05:50.470]and managing this the best they can.
[00:05:52.570]And I am taking the blame
[00:05:54.230]for some of this prevalence to continue
[00:05:57.020]and the worsening of problem behavior.
[00:05:58.560]And I'm saying maybe it's the solutions
[00:06:00.610]that we as professionals have been offered
[00:06:02.610]and at behavior analysts in particular.
[00:06:05.190]So, one of the first set of solutions,
[00:06:07.710]now we're going back at maybe a few years here,
[00:06:10.950]was to basically identify some powerful reinforcers,
[00:06:14.620]some arbitrary rewards, and some punishers
[00:06:17.530]and provide those.
[00:06:18.480]Try to override the actual reasons
[00:06:22.520]for why the individual was engaging in problem behavior.
[00:06:25.367]And kind of go with this attitude of maybe I don't care
[00:06:28.950]why you're engaging in problem behavior
[00:06:30.250]or maybe I do care, but I can't accommodate it.
[00:06:32.770]So, I'm going to override it
[00:06:34.750]with these powerful reinforcers and punishers,
[00:06:37.553]and try and teach you
[00:06:40.150]to tolerate some of these expectations.
[00:06:42.470]Now, those solutions maybe originally
[00:06:47.100]and immediately are quite reinforcing, right?
[00:06:49.800]Especially if a young,
[00:06:50.633]a child is young and you add some reward systems,
[00:06:53.910]you maybe had some success.
[00:06:55.470]So, we had some success as a field.
[00:06:57.010]Then, it was definitely better
[00:07:00.290]than what was happening before,
[00:07:01.460]especially with the arbitrary rewards.
[00:07:04.230]The problem is that it didn't really result
[00:07:07.270]in long-term effectiveness.
[00:07:08.940]It didn't really result in the individual
[00:07:11.150]actually being able to go through school, come out,
[00:07:13.810]and have a fulfilling life and community involvement.
[00:07:19.130]I'm gonna refer to these things as behavior modification.
[00:07:23.192]And that was sort of the term
[00:07:24.870]that was referred to as for behavior analysts originally.
[00:07:29.980]This involves also medication.
[00:07:31.740]A lot of medication was prescribed
[00:07:33.380]for basically overriding these behaviors.
[00:07:35.990]And the problem with the medication
[00:07:37.210]was that we don't have any medication
[00:07:39.860]that targets a particular topography of behavior.
[00:07:43.240]Generally speaking, all behaving kind of calms down.
[00:07:46.810]The individual stops responding
[00:07:49.086]and that's not good for the skills we wanna teach either.
[00:07:52.150]We don't have medication that will turn off aggression,
[00:07:55.700]but then turn on adaptive behavior
[00:07:58.470]and cooperation and toleration.
[00:08:00.690]So, we still would then have a difficult time teaching
[00:08:03.350]some of those skills.
[00:08:04.510]So, the next step for our field
[00:08:07.990]was to actually become a little humble
[00:08:10.540]and say we really need to have an understanding.
[00:08:14.030]We need to figure out why the individual
[00:08:16.390]is engaging in this behavior.
[00:08:18.400]And that's important before we try
[00:08:20.820]and change anything and teach anything.
[00:08:22.430]We gotta understand.
[00:08:24.260]And that was really the birth of behavior analysis
[00:08:27.530]as opposed to behavior modification.
[00:08:30.870]So, that was good.
[00:08:32.290]We're growing. I still want us to continue to grow.
[00:08:36.210]Now, there's a problem there too.
[00:08:38.360]With behavior analysis,
[00:08:43.010]two things happen.
[00:08:43.843]We did behavior mollification,
[00:08:46.300]as well as micro-analysis.
[00:08:49.040]And I'm gonna try and unpack these two things.
[00:08:51.520]Behavior mollification goes something like this.
[00:08:54.340]I understand what are some difficult situations,
[00:08:57.629]what are some triggers,
[00:09:00.540]what are some things that causes problem behavior
[00:09:02.537]and I'm gonna do my best to eliminate
[00:09:06.020]and minimize those triggers.
[00:09:07.990]So, you might do a lot of sort of preventative measures
[00:09:11.470]and remove a lot of these triggers,
[00:09:14.000]and try and make the world a better place
[00:09:16.520]for that individual, which is great.
[00:09:18.230]There is a place for behavior mollification.
[00:09:20.470]There's still a place for behavior mollification,
[00:09:22.980]but it's important to recognize
[00:09:25.220]that it also cannot be a lifestyle.
[00:09:27.690]It will not result in long-term increasing the involvement
[00:09:33.180]of that individual in life.
[00:09:35.090]I think yesterday, during dinner,
[00:09:36.250]I'm really sad that I missed most of the day yesterday.
[00:09:38.440]But during dinner, I learned some things.
[00:09:41.170]And you guys also highlighted the fact
[00:09:43.240]that you can't protect our kids from life, right?
[00:09:46.170]You can do your best to try
[00:09:47.310]and remove a lot of the triggers,
[00:09:49.510]but there comes a point where they're out in the world
[00:09:53.300]and those triggers are present
[00:09:54.870]or even to the best of your ability,
[00:09:56.950]you can't turn all the triggers off.
[00:09:59.270]So, you're still gonna have a situation
[00:10:00.750]where there's this explosive problem behavior.
[00:10:03.710]And it might even be worse
[00:10:04.900]because now there's no practice with it.
[00:10:07.910]You've tried and eliminate it
[00:10:09.080]and put it away as much as possible.
[00:10:10.700]A lot of positive behavior support does that.
[00:10:13.000]It's a great strategy.
[00:10:14.500]It is one we recommend to parents,
[00:10:16.260]especially during the pandemic.
[00:10:17.380]I recommended this a lot to really take a look and say,
[00:10:21.080]okay, we need safety right now.
[00:10:23.330]We need survival right now.
[00:10:24.720]We need to make sure that we don't have fights every day.
[00:10:27.820]So let's eliminate some of these expectations and triggers,
[00:10:31.550]and let's just reestablish peace and a joyful existence.
[00:10:36.350]But there needs to be a plan out of that.
[00:10:38.760]There needs to be...
[00:10:39.870]And you guys, the speakers yesterday highlighted that.
[00:10:43.883]That there needs to be gradual re-exposure to that
[00:10:47.360]and increasing those expectations.
[00:10:48.610]And that's the thing that didn't happen
[00:10:50.050]as much with behavior mollification.
[00:10:51.460]We're kind of stuck in that.
[00:10:53.250]With behavior micro-analysis, we then sort of decided
[00:10:57.910]to really understand the function of behavior.
[00:11:01.170]If you've worked with behavior analyst
[00:11:02.270]or if you're a behavior analysts,
[00:11:03.190]we've spent the last 30 years teaching ourselves
[00:11:06.110]and consumers to really care about the function,
[00:11:09.510]the one variable of why problem behaviors happening.
[00:11:14.100]And you may have heard things
[00:11:15.350]like it's attention maintained,
[00:11:17.400]it's escape maintained, it's for a tangible.
[00:11:20.080]It seems to be a thing that we were trying to identify,
[00:11:24.020]which was great.
[00:11:24.853]Maybe there's one particular variable.
[00:11:27.020]But here's the thing,
[00:11:27.853]I want you to really think about your own life.
[00:11:30.860]Think about something like laundry
[00:11:35.484]or cleaning your house.
[00:11:38.000]Something I do a lot.
[00:11:40.040]Sometimes.
[00:11:41.020]Now, it really depends,
[00:11:44.550]the extent to which I wanna escape laundry
[00:11:47.810]really depends what else is available.
[00:11:52.850]If I have to write a paper for Dr. Hanley,
[00:11:55.850]laundry all of a sudden is highly rewarding.
[00:11:59.880]Kids clothes, they're very...
[00:12:01.380]I mean, the laundry part is easy.
[00:12:02.520]The washing is easy.
[00:12:03.353]It's the folding and putting it away.
[00:12:05.540]I get to that. All the baskets are empty.
[00:12:08.920]By contrast, if it's Netflix and some yummy dessert I have,
[00:12:14.730]none of the clothes are getting folded.
[00:12:16.760]So the problem is by isolating maybe the variable
[00:12:21.830]and removing the context from it,
[00:12:24.400]we got to a very sort of lean thing
[00:12:28.280]that one, but kind of devoid of the context that mattered.
[00:12:31.710]So, it wasn't motivating enough
[00:12:32.910]if you tried to use that to teach.
[00:12:35.900]Or it just wasn't motivating enough
[00:12:37.940]to teach really difficult skills and teach a child
[00:12:42.050]to really tolerate some difficult triggers.
[00:12:45.090]We're asking them
[00:12:45.923]to really step outside of their comfort zone.
[00:12:48.510]Come with us and cooperate
[00:12:49.950]with some challenging expectations.
[00:12:52.390]And so, micro-analysis of this one variable.
[00:12:56.490]And then, you're trying to motivate a child
[00:12:58.350]with basically 30 second access to YouTube
[00:13:02.090]was just not enough.
[00:13:03.500]And we got stuck.
[00:13:04.900]So, what I'm hoping to do today
[00:13:07.460]is introduce you to a version of behavior analysis
[00:13:11.200]that's a little bit more practical
[00:13:13.750]and a little bit more ecologically valid.
[00:13:16.250]Looking at this whole context as it happens
[00:13:19.730]and really think about reinforcement happens in a context.
[00:13:22.870]Everything matter matters.
[00:13:24.730]What else is available, what else you need to do,
[00:13:27.650]and have this great motivating context
[00:13:31.280]that we can then use to teach.
[00:13:33.380]And also, although initially start
[00:13:35.820]with removing some of those triggers.
[00:13:37.350]So, there is some behavior mollification.
[00:13:40.070]And certainly, throughout there are times
[00:13:42.680]when your triggers are removed.
[00:13:45.350]If we were in situations every day, all day,
[00:13:48.780]that included our triggers,
[00:13:50.880]that would be a very exhausting day.
[00:13:52.790]You go throughout the day
[00:13:54.350]and you fluctuate in and out of instances
[00:13:57.680]where the world is your way
[00:13:59.760]and then the world is someone else's way.
[00:14:02.150]And we've just learned to tolerate that someone else's way,
[00:14:05.870]go along with someone else's preferences.
[00:14:08.570]Maybe you allow your friend to choose the restaurant.
[00:14:11.060]Maybe you allow your partner to decide what you,
[00:14:13.780]what movie you're gonna watch tonight.
[00:14:15.800]But if that was all the time,
[00:14:17.900]you would not hang out with that person.
[00:14:20.290]Sometimes, it's gotta be your way.
[00:14:22.160]And so, behavior mollification is always in place.
[00:14:24.650]We certainly can create and should create context
[00:14:27.210]in which the child has the world the way they want.
[00:14:30.440]But then, we do have to teach them
[00:14:32.870]to tolerate the world as is in other times.
[00:14:36.680]And to do that,
[00:14:37.570]we need really, really strong motivating context.
[00:14:40.680]And that's really the gist
[00:14:42.070]of what I'm hoping you take away today from this talk
[00:14:45.970]and the next two talks.
[00:14:47.980]And also, I really want us to become a little more gentle
[00:14:50.930]in the way we teach those skills.
[00:14:53.510]And a little bit more attentive to the child's performance
[00:14:56.880]and response to what we're trying to do and our procedures.
[00:15:03.970]Have I been moving this?
[00:15:05.740]You guys are like, "What is she doing?"
[00:15:08.010]All right.
[00:15:08.843]So the next message, which is a message of hope,
[00:15:11.500]is that freedom from severe problem behavior
[00:15:15.670]and greater community involvement is attainable
[00:15:18.930]for all persons with or without a disability,
[00:15:22.110]with or without ASD, with or without autism.
[00:15:25.030]It's possible for them. It's possible for their families.
[00:15:30.320]The next message is that this freedom is attainable
[00:15:35.360]and we can do this using behavior analysis,
[00:15:38.120]but completely consistent
[00:15:41.380]with the principles and values of trauma-informed care.
[00:15:45.110]Our field, in particular, has been a little bit late
[00:15:47.780]to this understanding, and I'm sorry about that.
[00:15:51.030]But we are trying to change that
[00:15:52.427]and we are trying to become more trauma-informed.
[00:15:55.450]And one of the ways we are becoming more trauma-informed
[00:15:59.700]is to become trauma-assumed
[00:16:01.590]and practice with that understanding.
[00:16:04.580]And I'll talk about that a little bit more.
[00:16:15.940]So, what I hope happens today
[00:16:18.310]is you come away and say Today's ABA is compassionate
[00:16:23.300]and is trauma-informed.
[00:16:25.080]This was a call that was published
[00:16:27.360]in our flagship journal as well,
[00:16:28.940]by some much better scholars than me.
[00:16:33.160]Dr. Rajarama and colleagues published their paper
[00:16:36.640]and basically invited all behavior analysts
[00:16:39.840]to include this in their practice,
[00:16:41.920]to consider it in their work, study it more.
[00:16:46.280]But really to change their practice from today
[00:16:50.760]and incorporate some of the components
[00:16:53.180]of trauma-informed care.
[00:16:54.510]Bring this into their commitments to their,
[00:16:57.750]the people that they serve.
[00:16:58.810]And my colleagues and I have certainly done this.
[00:17:01.070]And really, what we want to do
[00:17:03.930]is to get to this freedom from problem behavior
[00:17:07.720]by staying consistent with this approach.
[00:17:16.400]If you haven't already done so,
[00:17:19.070]I really encourage you to listen to a "TED Talk,"
[00:17:22.380]by Dr. Friman who's a much better speaker.
[00:17:25.800]He's a great leader of our field
[00:17:27.450]who's been calling for this actually way before
[00:17:31.270]I even became informed about this concept.
[00:17:35.740]And also, Dr. Hanley's paper on "Today's ABA,"
[00:17:39.110]that's freely available both of those (inaudible).
[00:17:41.990]Just so you guys know,
[00:17:42.840]these slides will be available to you.
[00:17:44.570]So, you don't need to write frantic notes or anything.
[00:17:46.910]I will have them email to you after the talk.
[00:17:50.070]And you'll have the links for these two resources.
[00:17:53.550]And it's really inspiring to both listen to Dr. Friman
[00:17:57.430]and also read what Dr. Hanley is saying.
[00:17:59.230]And it's good because he comes
[00:18:01.730]from that traditional ABA training practice background.
[00:18:06.070]And so do I.
[00:18:07.090]So, some of the things I'm talking to you guys about,
[00:18:09.120]the shift I'm asking us to make, I have gone through it.
[00:18:12.760]I'm going through it and I know how challenging it is.
[00:18:15.860]And I also know how challenging it is
[00:18:17.440]because now all of a sudden,
[00:18:19.360]parents, and teachers, and staff, and employees
[00:18:23.810]that we've been talking to,
[00:18:24.870]that we've been recommending to do something,
[00:18:27.140]you're gonna show up
[00:18:27.973]and you're gonna tell 'em to do something totally different.
[00:18:30.330]So, I call it out. I acknowledge it.
[00:18:33.440]I say I know this is completely a shift and different
[00:18:37.530]than what I was asking you to do before,
[00:18:40.170]but come along with me with this journey.
[00:18:42.910]And to give them the rationale
[00:18:44.570]and to really say we've learned.
[00:18:46.820]We really have learned.
[00:18:47.670]We're trying to respond to our data.
[00:18:49.360]And our data on behavior analysis is very clear.
[00:18:51.450]We published a study on functional communication training,
[00:18:54.380]which is one of our most popular treatments
[00:18:56.880]for problem behavior.
[00:18:57.713]So, it's a pretty good reflection of where the field is.
[00:19:01.497]And we have beautiful data, very extensive data.
[00:19:04.820]on its efficacy.
[00:19:06.440]Meaning this treatment
[00:19:08.430]thus eliminate problem behavior immediately
[00:19:11.520]and quite drastically,
[00:19:13.510]but we don't have really good data on its effectiveness.
[00:19:16.020]And there is a difference
[00:19:16.910]between efficacy and effectiveness.
[00:19:19.010]Effectiveness is talking about can mom do it,
[00:19:22.450]can grandma do it, can the teacher do it, will it maintain,
[00:19:25.290]will it always generalize to other environments,
[00:19:27.270]will it happen in church,
[00:19:28.190]will it happen in the grocery store,
[00:19:29.890]do we have effects maintain throughout life
[00:19:33.500]in all the community sort of involvement
[00:19:35.340]that needs those repertoires to happen.
[00:19:38.090]We don't have good data on that.
[00:19:40.180]And the data that we do have,
[00:19:42.020]the studies that we do have
[00:19:44.010]point to an important component,
[00:19:47.730]which is this skill building component
[00:19:49.520]that I'm gonna talk to you guys about.
[00:19:50.940]So, simply teaching communication
[00:19:53.700]and using some of the extinction and punishment procedures
[00:19:56.920]that we had in place before for problem behavior
[00:19:59.170]is not sufficient.
[00:20:00.570]Because after communication,
[00:20:01.990]you have to tolerate and cooperate.
[00:20:04.230]'Cause even though you might ask nicely your requests,
[00:20:08.520]all of our requests are not always granted immediately.
[00:20:11.040]And then, you're left with a lack of skills.
[00:20:14.700]And unless we teach those skills,
[00:20:16.380]it doesn't matter how powerful
[00:20:18.130]your arbitrary reinforcers are and punishers are,
[00:20:20.890]problem behavior will reemerge
[00:20:22.770]because the individual simply doesn't know what else to do.
[00:20:26.240]You haven't eliminated the need and that gap.
[00:20:32.340]Okay.
[00:20:33.520]So, just in case there's...
[00:20:34.690]I know you guys are very well informed,
[00:20:36.420]so I might breeze through this.
[00:20:37.710]Because I talk to a few people
[00:20:39.450]and I know some of your districts
[00:20:40.780]are very much trauma-informed.
[00:20:42.457]And so, I'm just gonna do a quick review
[00:20:44.730]because for me, it was certainly eye opening
[00:20:47.500]of what is trauma-informed care and what is trauma.
[00:20:50.740]Because when I was thinking about trauma,
[00:20:53.970]perhaps my understanding was a little bit limited.
[00:20:58.250]But trauma-informed care has really come
[00:21:00.870]to the forefront for many professionals and many fields,
[00:21:04.760]especially in fields that work with individuals
[00:21:08.060]that most of us serve and the kids that you guys serve.
[00:21:11.647]And as I mentioned, we're a little bit late to the game
[00:21:14.610]but we're trying to catch up.
[00:21:18.890]Now, definitions of trauma-informed care may vary.
[00:21:22.900]There might be some different phrasings and whatnot,
[00:21:27.630]but there seems to be five core components
[00:21:30.830]that they all share.
[00:21:32.190]And it's the emphasis on these components
[00:21:34.360]as you try and work with kids and teach them anything
[00:21:39.020]is to consider these five components.
[00:21:41.350]One is safety,
[00:21:44.080]choice, collaboration,
[00:21:47.050]trustworthiness, and empowerment.
[00:21:50.650]And it's really to talking about,
[00:21:52.150]if you think about trauma
[00:21:54.080]and someone that has experienced trauma,
[00:21:55.640]what's common between those traumatic experiences
[00:21:58.910]is this lack of control,
[00:22:00.940]lack of ability to sort of make decisions for yourself.
[00:22:04.480]So at the very least what we want to do
[00:22:06.880]when we start to work with kids and their families
[00:22:10.430]is to give back some that control.
[00:22:13.390]To have them be in the driver's seat.
[00:22:16.670]And obviously, the last thing we wanna do
[00:22:20.160]is to do anything that retraumatizes that child.
[00:22:24.890]So, I'm gonna be talking about these five components
[00:22:29.220]in various forms and how we are incorporating it now
[00:22:31.720]in the assessment and treatment of our problem,
[00:22:33.220]of problem behavior and the approach that I do.
[00:22:35.860]And always keeping these in sort of the forefront
[00:22:39.610]and making sure that whatever we're doing
[00:22:42.240]is staying in line with these components,
[00:22:44.400]with these commitments.
[00:22:48.230]Trauma is also hard to define.
[00:22:50.330]And I think one of my mistakes, initially,
[00:22:53.850]when I was presented with this idea
[00:22:56.080]was to think of trauma as a very significant large event.
[00:23:01.500]Things that maybe we typically think about.
[00:23:03.740]One situation, maybe I was thinking about
[00:23:06.950]a pretty significant sexual abuse, physical abuse,
[00:23:09.750]children that have been in war zones,
[00:23:12.190]rally tragedies and significant losses that way.
[00:23:16.910]But I was failing in my understanding a little bit,
[00:23:20.390]which was impacting sort of the work that I was doing
[00:23:22.550]with kids and families.
[00:23:24.070]So, I do wanna take a moment for all of us
[00:23:27.350]to imagine some of these other scenarios.
[00:23:34.120]So, I want you to imagine
[00:23:38.060]the frustration that a child might experience
[00:23:42.150]day in and day out, all day,
[00:23:46.250]when they don't really have a way
[00:23:48.090]of communicating their wants and needs.
[00:23:50.780]And when they do or try to, nobody understands.
[00:23:56.480]Okay, I know that we've all
[00:23:57.870]have probably been in a situation
[00:23:59.470]where we attempted to communicate something
[00:24:01.127]and the person didn't understand
[00:24:03.070]or maybe you've been abroad
[00:24:04.550]and you didn't speak the language.
[00:24:06.160]It's very, very frustrating.
[00:24:07.610]Now, imagine that every single day.
[00:24:13.810]Might this constitute trauma?
[00:24:15.460]This is the part that I was kind of missing.
[00:24:17.950]That some of the kids I was working with
[00:24:20.160]have already gone through years of this
[00:24:22.580]by the time they were sitting in front of me
[00:24:25.150]and I was trying to do something.
[00:24:26.780]Now, imagine that that same person
[00:24:29.480]who's had this frustrating experience
[00:24:33.220]is so frustrated that they have to actually resort
[00:24:36.030]to some of those behaviors that we talked about,
[00:24:37.990]aggression, self-injury, severe meltdowns.
[00:24:41.080]Just the act of engaging in those behaviors,
[00:24:43.480]you all know when you get angry,
[00:24:45.570]it's a very emotional experience.
[00:24:47.500]You yourself are all worked up.
[00:24:49.750]Even if it's a aggression.
[00:24:51.130]Even if you're aggressing towards someone else,
[00:24:52.760]you yourself are quite impacted.
[00:24:55.190]So every time the child is going to that point,
[00:24:58.670]they're reliving a traumatic event
[00:25:02.060]and I was failing to really recognize that.
[00:25:05.120]And we were failing to recognize that.
[00:25:06.910]A lot of our recommendations over the years
[00:25:09.470]were to ignore milder forms of problem behavior,
[00:25:13.040]to ignore attempts to communicate,
[00:25:15.220]to ignore refusals and pulling away.
[00:25:17.990]And it wasn't until the child went all the way
[00:25:20.840]to aggression and self-injury,
[00:25:22.230]and throwing a desk and maybe a complete meltdown,
[00:25:26.610]we didn't really respect and remove things.
[00:25:28.690]The child had to go there for us to say,
[00:25:30.520]okay, now we gotta remove them from the classroom.
[00:25:32.390]Now, you don't have to do your math.
[00:25:33.900]Okay, fine, we don't have to do bath time right now.
[00:25:36.720]And basically, give them what they want in the first place.
[00:25:39.337]And they were trying to tell us
[00:25:40.880]that I don't wanna do this right now.
[00:25:42.610]But we not only ignored those attempts of communication,
[00:25:46.040]even if we did understand it,
[00:25:48.010]we let them go all the way before we said okay.
[00:25:52.830]Because sometimes you didn't have a choice.
[00:25:55.120]But this might also be something we consider now
[00:25:58.350]as a traumatic event.
[00:25:59.740]And we really wanna eliminate instances
[00:26:03.360]where the child has to go there
[00:26:05.780]or the individual really, at any age.
[00:26:09.140]And then, of course, the list gets worse.
[00:26:12.770]And again, I'm going in my mind
[00:26:15.120]through my own behavior plans here.
[00:26:16.890]So, please don't take this personally.
[00:26:19.360]This speaks to me as much as anybody else.
[00:26:21.570]What was my recommendation for some of these things?
[00:26:26.250]I forget that you guys can't see what I see, sorry.
[00:26:31.640]I recommend time out, punishment, escape extinction
[00:26:36.460]for some of these behaviors that were happening.
[00:26:38.550]If behavior intervention,
[00:26:39.770]we finally came in and we were doing treatment,
[00:26:41.910]a lot of our treatments for severe problem behavior
[00:26:43.780]included these things.
[00:26:45.400]So, we're just kind of adding on.
[00:26:47.160]It doesn't get any easier for this little kiddo.
[00:26:52.170]And then, of course, as that child gets older,
[00:26:55.820]the next thing that happens
[00:26:57.390]if severe problem behavior is present,
[00:27:00.380]we see prolonged and repeated physical management
[00:27:03.210]in the form of restraints or chemical restraints.
[00:27:06.810]But that's kind of the trajectory that we had.
[00:27:09.529]And this is what I failed to recognize.
[00:27:11.450]That these are all traumatic events
[00:27:14.150]and this cumulative effect
[00:27:15.910]of little, little, little experiences
[00:27:18.260]can be just as damaging, can be just as difficult.
[00:27:22.190]And so now, my colleagues and I
[00:27:27.180]have basically come a way
[00:27:29.840]with a safe assumption
[00:27:32.930]and more, I guess, responsive assumption
[00:27:36.580]that every child, every family, every individual
[00:27:39.590]that needs our services, that I'm working with
[00:27:43.470]has already experienced trauma.
[00:27:45.920]I'm gonna go based on that assumption.
[00:27:48.200]Because most of the kids I work with,
[00:27:50.280]most of the individuals I work with
[00:27:52.030]do have deficits in their communication.
[00:27:56.837]And at the very least, do have deficits
[00:27:58.880]in their toleration and cooperation,
[00:28:00.780]and have repeatedly engaged in problem behavior.
[00:28:03.660]So, I'm just gonna assume
[00:28:05.170]that you already are someone who is impacted by trauma.
[00:28:09.410]And I need to be very sensitive and not add to that.
[00:28:22.140]So, the authors of this paper
[00:28:25.450]in journal behavior analysis
[00:28:27.380]basically asked us behavior analysts
[00:28:29.500]to have these five commitments in our practice.
[00:28:36.030]They did ask us to acknowledge
[00:28:38.770]and basically assume trauma and its potential impact
[00:28:42.570]on every person we serve.
[00:28:44.090]They asked us to first and foremost, ensure safety.
[00:28:47.450]Let's avoid problem behavior to the extent possible.
[00:28:51.820]Whatever you need to do in that moment
[00:28:54.430]to keep everybody safe, do it.
[00:28:57.370]Now, this is a departure because our recommendations before
[00:29:00.490]were not to reinforce problem behavior.
[00:29:03.850]There was a lot of emphasis on this,
[00:29:06.060]parents, and caregivers, and teachers, and everybody, don't.
[00:29:09.470]Did you reinforce problem behavior?
[00:29:10.700]Did you give in?
[00:29:11.760]Did you give him what he wanted?
[00:29:13.641]And, of course, parents lied to me.
[00:29:15.220]I would too.
[00:29:16.053]I'll be like no, never.
[00:29:18.070]If you asked,
[00:29:19.560]they would tell you the behavior plan you wrote,
[00:29:21.420]not what life is.
[00:29:24.169]I put that on a daily basis with a three-year-old
[00:29:26.880]is upset about something every day and we just survive.
[00:29:29.840]I pick my battles.
[00:29:31.880]And so, I can only imagine
[00:29:33.770]that this was certainly not something
[00:29:35.960]that parents were doing, but we were doing it.
[00:29:38.390]And we were forcing them
[00:29:39.430]when we were watching them to do it.
[00:29:42.500]And so, really, override safety in many instances
[00:29:46.810]in the name of those procedures.
[00:29:49.970]But now, we're saying, look, let's start with safety.
[00:29:52.850]Let's start with trust.
[00:29:54.320]Let's start with choice and shared governance.
[00:29:57.220]Let give this individual a voice first.
[00:30:02.350]We truly let them choose the world
[00:30:06.830]the way they want it to be in this moment.
[00:30:08.530]Give them back some control.
[00:30:10.570]Go along with their preferences for a little bit,
[00:30:13.470]even if it doesn't make sense to you,
[00:30:16.100]before you ask them to go along with ours.
[00:30:19.520]We have to first meet the child where they at
[00:30:22.300]and this is what the authors are really asking us.
[00:30:25.030]And then, we can talk about skill building.
[00:30:27.540]But I think what we were doing
[00:30:29.100]and the reason it wasn't working for so long
[00:30:31.560]was that we were trying to teach skills
[00:30:34.820]in the midst of this emotional responding
[00:30:37.600]and severe problem behavior.
[00:30:38.820]We're trying to work through problem behavior and teach.
[00:30:41.370]Have you ever tried to learn something
[00:30:42.900]when you're super upset and emotional?
[00:30:45.070]It really doesn't work.
[00:30:46.560]And so, it's not a surprise
[00:30:48.800]that we really were not that successful.
[00:31:08.240]So, what are the hallmarks of this new approach
[00:31:10.800]that I'm speaking of this Today's ABA,
[00:31:13.640]with respect to assessment
[00:31:14.940]and treatment of problem behavior.
[00:31:16.170]How do we go about doing it?
[00:31:17.610]How do we stay consistent with those commitments
[00:31:20.430]and still get to the results we need?
[00:31:23.440]I said it's more than just behavior mollification.
[00:31:26.860]Well, to start Today's ABA
[00:31:32.730]says we gotta listen first.
[00:31:35.240]Don't come in and try and do assessments
[00:31:38.010]through direct observation,
[00:31:40.720]through developmental assessments.
[00:31:43.360]Don't try and override the experts
[00:31:46.120]that are already in that environment,
[00:31:47.890]which are the parents and the teachers
[00:31:49.810]and the people that are usually working
[00:31:52.890]with that individual.
[00:31:54.040]They know a lot.
[00:31:55.620]I don't need, really, weeks and months of data,
[00:31:59.940]frequency data on severe problem behavior
[00:32:02.550]to know that it's interfering.
[00:32:04.190]I could just ask the teacher.
[00:32:05.800]Is problem behavior interfering
[00:32:07.290]with your student's learning?
[00:32:10.700]I can ask mom.
[00:32:11.710]Is problem behavior interfering
[00:32:13.060]with you going to the grocery store with your child?
[00:32:15.330]She can gimme the information
[00:32:17.160]and a lot of really rich qualitative details
[00:32:20.460]about exactly when it would be a problem
[00:32:22.680]and when it would not be a problem,
[00:32:24.030]and how she manages to go to the grocery store
[00:32:27.380]and survive it.
[00:32:28.800]Or the teacher could tell me exactly
[00:32:30.870]what type of demand presentation
[00:32:32.370]would result in problem behavior and what wouldn't.
[00:32:35.530]Information that would not actually be present
[00:32:37.930]if I went and looked at frequency data.
[00:32:40.950]Information that I would have to like literally be in living
[00:32:44.300]with those individuals for months
[00:32:46.230]to gather through direct observation.
[00:32:48.880]I no longer collect any natural observation data
[00:32:54.670]because basically, it's like saying your experience,
[00:32:57.960]who's been with this child for like years, doesn't matter.
[00:33:01.340]Let me come and watch this child.
[00:33:03.210]You can't possibly tell me what's going on.
[00:33:05.340]And now, I'm saying I'm sorry, you do know what's going on.
[00:33:07.840]Tell me what's going on. Let me just write the notes down.
[00:33:11.080]Okay.
[00:33:12.200]Because here's the thing.
[00:33:13.120]If we're concerned about reliability
[00:33:15.150]and if we're concerned about maybe what we see
[00:33:18.690]in that instance of observation
[00:33:21.600]is not as accurate,
[00:33:24.700]Whether you ask an informant to give you the information
[00:33:27.330]or you go watch it, it's no different.
[00:33:29.709]You're still getting an instance.
[00:33:31.470]And in fact, they have a much larger sample
[00:33:35.030]'cause they've been working and living with that individual
[00:33:37.450]for a long time.
[00:33:38.283]They can give you a lot better assessment than you can
[00:33:41.750]in these snippets that you go and get.
[00:33:45.400]And that really doesn't do anything
[00:33:47.320]to build any kind of a relationship.
[00:33:49.180]Imagine someone coming to my house and saying,
[00:33:52.607]"Okay ma'am, don't worry about it.
[00:33:54.580]I've got my clipboard.
[00:33:56.380]I'm just gonna watch what you do with your kid."
[00:34:00.562]Talk a about not getting buy-in.
[00:34:02.970]Now, by contrast, if someone came in
[00:34:06.030]and asked me what's going on
[00:34:07.790]and wrote down the words that are coming outta my mouth
[00:34:11.640]and based an assessment and treatment on that,
[00:34:14.940]I think we would have a much better collaboration
[00:34:17.320]and relationship.
[00:34:18.540]All of a sudden I'm a partner.
[00:34:20.400]I'm not dismiss.
[00:34:23.230]So, we are really saying let's start
[00:34:26.010]by asking people that know the individual
[00:34:29.810]and the individual themselves to the extent possible.
[00:34:33.360]A lot of our learners can actually talk for themselves.
[00:34:35.510]They can tell us like what's what's going on,
[00:34:37.950]why are you upset, why don't you wanna go to math,
[00:34:41.460]what's hard about the grocery store.
[00:34:44.110]And maybe the child themselves
[00:34:45.430]can tell us exactly what's going on, what they want,
[00:34:47.720]what they don't want.
[00:34:49.180]And so to the extent possible, the client.
[00:34:51.390]And if not, those that are really the experts and not you.
[00:34:55.940]So, that's the first step.
[00:34:57.270]First for us is to ask questions, gather information.
[00:35:00.510]And yes, it's indirect.
[00:35:02.460]And as behavior analyst,
[00:35:03.750]we've been a little bit worried about that.
[00:35:05.570]I'm saying let's not.
[00:35:09.470]Then, the second thing we're gonna do.
[00:35:11.440]And this is why I'm not worried about it.
[00:35:14.260]Again, if you're a behavior analyst,
[00:35:15.630]if you're sitting for the exam,
[00:35:17.060]they're gonna ask you why wouldn't you rely
[00:35:19.250]on indirect assessments?
[00:35:20.810]And you have to say,
[00:35:21.643]"Because they're unreliable."
[00:35:23.850]And you're correct.
[00:35:25.560]They are correct.
[00:35:27.410]It's not a hundred percent reliable.
[00:35:29.510]But what I'm suggesting here is not for us to simply ask
[00:35:32.950]and only rely on that information.
[00:35:35.490]I'm saying let's cut down
[00:35:37.420]on some of the other assessments we were doing.
[00:35:39.750]And instead, ask the parents, ask the teachers
[00:35:42.570]to describe the situation to us
[00:35:44.620]and then test those hypotheses as they described it.
[00:35:48.830]So, you are still doing an analysis.
[00:35:50.427]You're not just relying on this information.
[00:35:54.100]Just in case you go to your test,
[00:35:55.760]I don't want you to fail because I said this, okay.
[00:36:02.742]Then, the next thing we're gonna do
[00:36:04.120]and this is the part that I really think
[00:36:07.150]I'm sometimes embarrassed to imagine
[00:36:09.460]that, wow, we really didn't think of this in 30 years.
[00:36:13.530]We're just thinking about it now.
[00:36:15.790]I want us to create a context,
[00:36:17.680]based on the description given to us by those caregivers,
[00:36:21.360]by those experts, by the clients,
[00:36:23.630]in which problem behavior is zero.
[00:36:27.070]Can we do that first?
[00:36:29.040]Can we have a context that the child is truly happy?
[00:36:32.350]It's where they wanna be.
[00:36:33.600]Not because you brought them into that room
[00:36:35.870]and closed the door and said,
[00:36:37.007]"You have to stay here
[00:36:38.850]'cause we're doing an assessment,"
[00:36:40.720]but because the room is awesome.
[00:36:42.890]The door is open.
[00:36:43.950]They can leave and they don't.
[00:36:47.580]That's very different.
[00:36:48.520]All of my dissertation, all of my papers are published,
[00:36:51.050]the door was closed.
[00:36:54.130]We came in and we said this is what's going on,
[00:36:56.010]the door was closed.
[00:36:57.280]And then, 10 minutes.
[00:36:59.770]Of course, we had assent in the sense
[00:37:02.040]that we thought, okay, well I asked the client
[00:37:04.430]if they wanted to common and they did.
[00:37:05.650]And the parents have consented through this happening.
[00:37:07.500]So, we're okay.
[00:37:09.010]But now we're saying, mm.
[00:37:11.230]Assent can be given and removed.
[00:37:15.070]It's not like hey, you agreed to have tea,
[00:37:16.970]now you better finish it.
[00:37:19.960]So the child can decide, yes, they're coming with us
[00:37:22.500]and they can leave.
[00:37:23.380]The door is open.
[00:37:25.100]And if they leave, we should (static drowns out speaker).
[00:37:30.320]And then, create context that they don't wanna leave.
[00:37:32.880]And that's where we gotta start.
[00:37:34.940]We gotta start with the context
[00:37:36.103]that the child wants to actually stay in.
[00:37:38.660]There's zero instances of problem behavior.
[00:37:40.670]You really get an understanding that way.
[00:37:43.855]And if you ask mom and teachers, a lot of times,
[00:37:46.690]they're very good at coming up with this context, actually.
[00:37:51.368]You say,
[00:37:52.201]"Hey, there's some really important people
[00:37:53.290]coming to your house.
[00:37:54.610]You really don't wanna deal with problem behavior.
[00:37:57.740]You really need your child to be happy. What would you do?"
[00:38:00.150]Mom will describe exactly what this context will look like
[00:38:03.160]and she's the best expert at it.
[00:38:05.720]I know.
[00:38:06.553]I now have one of those mom purses
[00:38:07.670]where I pull stuff out of.
[00:38:10.530]They know. They can help you create it.
[00:38:14.830]And then, what we're looking for for the client, of course,
[00:38:18.890]is that this is really truly a context
[00:38:21.002]that they're happy, relaxed, engaged.
[00:38:23.660]If you're working with people from FTF
[00:38:25.820]or any of our consultants,
[00:38:26.980]or people that have been trained by us,
[00:38:28.340]you're gonna hear about HRE.
[00:38:30.700]My HRE is this.
[00:38:32.040]My HRE is Starbucks in the morning.
[00:38:34.460]So, I'm sorry.
[00:38:36.018]We're bad at like making words up.
[00:38:39.760]This one is a little bit better than IISCA.
[00:38:45.070]So, we're looking for a child to be happy,
[00:38:47.420]relaxed, and engaged.
[00:38:49.360]And we're looking at experts to tell us are they happy,
[00:38:52.880]relaxed, and engaged?
[00:38:53.990]And they tell us that...
[00:38:55.760]I got scared for a second.
[00:38:56.700]My computer is like the Eastern time. It says 10:20.
[00:38:59.710]I'm like, oh my goodness.
[00:39:01.520]Okay.
[00:39:02.353]I have another hour.
[00:39:05.240]So, we ask mom, we ask people
[00:39:07.960]that know the child to be there and to tell us.
[00:39:10.930]And what's important about this context
[00:39:13.420]and creating this context
[00:39:14.670]is that it's not only out stuff.
[00:39:17.260]The stuff part is easy.
[00:39:19.090]You figure out what the child likes to play with,
[00:39:21.420]what are some activities.
[00:39:22.760]You bring all those things in as much as possible.
[00:39:25.240]I know there might be things we can't include,
[00:39:27.020]but I really push people to think
[00:39:28.700]about okay, what is it about this that needs to be in here?
[00:39:32.180]I had this one client, who I love.
[00:39:33.650]I could probably be really good friends with her.
[00:39:35.650]She love really fancy grocery stores.
[00:39:40.310]The ones with like fancy pasta and cheese and chocolate.
[00:39:44.210]And she loved going there.
[00:39:45.600]And everybody was like,
[00:39:46.433]"No, no, we can't have happy, relax, engage at home.
[00:39:48.900]It's about going to these grocery stores."
[00:39:51.050]I'm like what does she do at the grocery stores?
[00:39:53.610]So, what ended up happening is we created
[00:39:56.570]the same thing she was accessing in the grocery store.
[00:39:59.490]We got a bunch of fancy cheese and packaging,
[00:40:02.100]and made sure things were like really fancy
[00:40:05.590]and sitting around.
[00:40:07.190]And she loved that.
[00:40:08.090]She loved discovering.
[00:40:09.170]And it was a little bit of a hunt for finding things
[00:40:13.460]and unwrapping things and opening things up.
[00:40:15.600]What was awesome, which mom really appreciated,
[00:40:17.760]was that if you bought a block of cheese, that was $30.
[00:40:21.190]She only wanted a little bit of it, obviously, that day.
[00:40:24.030]If you just packed it right back with that fancy stuff
[00:40:26.870]and presented it the next day, it was okay.
[00:40:28.618]You don't have to buy another $30 block of cheese.
[00:40:31.220]So at first, people are also concerned like,
[00:40:32.847]"I can't do this.
[00:40:33.680]It's gonna cost a hundred dollars every day."
[00:40:35.690]But it really doesn't
[00:40:36.523]if you just are a little were creative with it.
[00:40:39.330]And so, she loved those things.
[00:40:40.670]We got those things. We brought them in.
[00:40:42.670]But it wasn't just about those things.
[00:40:45.770]It has to do a lot with the type of interaction
[00:40:49.330]that the individual prefers as well.
[00:40:52.130]One of the things we notice about outings.
[00:40:55.140]She was older.
[00:40:56.310]So she was a, actually than a teenager,
[00:40:58.830]maybe 20 years old.
[00:41:00.590]And one of the things that she never had
[00:41:03.570]was there was very limited time in the day
[00:41:07.660]that she had her iPad and she had her stuff,
[00:41:10.600]and people were leaving her alone.
[00:41:12.810]There was always somebody with her.
[00:41:14.940]And even if they weren't presenting demands
[00:41:17.560]and interruptions and expectations in a traditional sense,
[00:41:21.510]they attempted to interact with her
[00:41:22.940]by commenting on what she was watching.
[00:41:25.460]So she was like on her YouTube or whatever she was doing,
[00:41:28.010]and people would be like,
[00:41:29.037]"Oh, what are you watching? Who's that?
[00:41:30.470]Is that a really fun?" blah, blah, blah.
[00:41:32.130]Imagine that when you're watching Netflix.
[00:41:34.950]My husband and I sometimes get into a fight over that.
[00:41:38.140]Zip it.
[00:41:39.850]And that's what it was.
[00:41:41.520]It was when she was out
[00:41:44.890]and they were going to these grocery store,
[00:41:47.460]in those moments of the day,
[00:41:49.380]her workers were busy navigating the driving
[00:41:53.970]and actually left her alone.
[00:41:55.260]She was in the backseat
[00:41:57.100]and she had some nice uninterrupted,
[00:42:00.730]no attempts to communicate and like enrich her environment.
[00:42:04.070]And people were trying to be helpful
[00:42:05.900]and trying to not ignore her,
[00:42:07.690]but really that's not what she wanted.
[00:42:08.800]Sometimes, she did.
[00:42:10.090]And she would fluctuate in and out of that.
[00:42:12.390]And it was very clear.
[00:42:13.400]You could see when she was asking for attention,
[00:42:16.970]when she wanted an audience,
[00:42:18.300]when she wanted you to be engaged,
[00:42:19.700]and when she was like, "Leave me alone."
[00:42:23.390]And so in this HRE context,
[00:42:25.400]we really wanna figure out also how the rest of us
[00:42:29.490]should act (static drowns out speaker).
[00:42:31.104]Should we be close?
[00:42:32.430]Should we be far away?
[00:42:34.700]Should we comment?
[00:42:36.320]We ask a lot of questions.
[00:42:38.360]I even find myself,
[00:42:40.350]when I try to talk to my four-year-old,
[00:42:42.100]I ask a lot of questions
[00:42:44.200]in an attempt to communicate with her.
[00:42:46.900]We don't comment as much as we ask questions.
[00:42:49.470]It's sort of like a rhetorical question
[00:42:51.490]or a question we don't maybe expect an answer to.
[00:42:54.120]But for some of our learner who are with us
[00:42:56.200]and in educational settings
[00:42:57.500]and treatments for like 20, 40 hours a week,
[00:43:00.090]it's a lot of being asked.
[00:43:04.780]So, we try and figure that out.
[00:43:06.600]The other thing we try and do in this context
[00:43:08.830]is, of course, we call it HRE,
[00:43:10.720]but that's not necessarily accurate
[00:43:13.540]for all of our learners either.
[00:43:15.160]Teenagers, sometimes it's not cool to be happy or too happy.
[00:43:19.210]They're just content.
[00:43:20.387]I'd be happy with that.
[00:43:22.340]So that might be a, maybe a CRE.
[00:43:27.300]And then if you're really like excited,
[00:43:29.350]Greg uses the example of maybe a rock star
[00:43:32.220]playing the drums.
[00:43:33.660]That guy doesn't look relaxed,
[00:43:35.630]but he's in his happy for place.
[00:43:37.230]So, he might look jacked.
[00:43:38.320]And some of our kids
[00:43:39.153]might be in their best stereotypical routine
[00:43:43.340]and they are super hyper, super jacked.
[00:43:46.290]That's where they wanna be. Don't interrupt that.
[00:43:47.940]Don't try and calm that down.
[00:43:49.140]So, it's really understanding the child better
[00:43:52.420]and allowing these sort of flexibility
[00:43:56.210]in what we can consider HRE as well.
[00:43:59.690]And again, moms and teachers,
[00:44:01.450]people that know that individual
[00:44:02.710]can really help us identify do we have this context or not.
[00:44:08.430]And we think we gotta have that before we can go forward.
[00:44:11.790]And the bonus would be if we have this context,
[00:44:15.630]the individual's happy, relaxed, and engaged,
[00:44:18.320]and this individual makes some social bits
[00:44:22.500]for your attention.
[00:44:23.760]They're not just avoiding you.
[00:44:25.870]If you're trying to teach a child
[00:44:28.690]and all they wanna do is avoid you,
[00:44:30.580]it's not a good place to start.
[00:44:32.600]So, we're looking for also by maybe backing off,
[00:44:36.670]zipping it a little bit,
[00:44:38.360]letting the child do things.
[00:44:39.760]Do less supervision. Do less directing.
[00:44:42.810]Enjoy in their shared experience.
[00:44:45.040]Well, they now be more open and approach you
[00:44:47.610]and actually want to hang out with you
[00:44:50.490]because that's the key to being a good teacher.
[00:44:54.450]When you think about good teachers,
[00:44:57.470]you wanted to hang out with them.
[00:44:58.660]You wanted to do what they wanted you to do.
[00:45:01.360]You wanted to go along.
[00:45:02.730]And then, you were willing
[00:45:03.920]to step outside of your comfort zone a little bit
[00:45:06.450]and try those difficult things with that teacher.
[00:45:09.160]And that's important.
[00:45:10.366]That's something that we really are trying to get to.
[00:45:22.240]If there isn't any problem behavior,
[00:45:24.210]any severe problem behavior,
[00:45:25.580]what we're saying is it's not time yet to teach.
[00:45:28.820]Now with some of our learners, some of our students,
[00:45:32.060]this might take five minutes.
[00:45:33.660]With some, it might take 10 minutes.
[00:45:35.090]Unfortunately, with some of our older kids
[00:45:38.120]who have been actually in treatment for a very long time,
[00:45:42.320]sometimes it takes hours.
[00:45:43.670]Sometimes it takes weeks for us just to get to HRE.
[00:45:47.980]Because some of our kids have been overly managed,
[00:45:50.650]overly scheduled, overly directed.
[00:45:53.010]And the first few hours with some of our learners,
[00:45:57.420]they're just trying to figure out,
[00:45:59.007]"What is you want me to do?
[00:46:00.720]Let me do it 'cause I know how this game works."
[00:46:04.400]And it's very sad.
[00:46:05.844]First step really is to give some agency back and say,
[00:46:10.047]"No, no, you get to decide.
[00:46:12.260]We don't have to do what I wanna do.
[00:46:13.980]We're not on my schedule yet.
[00:46:16.110]You tell me what you wanna do."
[00:46:17.890]And we gotta be patient
[00:46:19.390]and we gotta wait until we get that.
[00:46:23.480]No more time-based analysis.
[00:46:27.560]No more time-based assessments
[00:46:29.160]where it's like, okay, five minutes of control,
[00:46:31.260]five minutes of test, 30 seconds of the reinforcement.
[00:46:34.040]It's all performance-based.
[00:46:36.980]It might be four hours HRE
[00:46:38.780]before or attempting to HRE
[00:46:41.210]before we start to see, okay, what are some of the triggers
[00:46:44.577]and what are some things we can teach.
[00:46:48.500]But we do figure it out.
[00:46:50.090]And when we figure it out, when we have the HRE,
[00:46:52.380]the next step then is to empower the learner
[00:46:57.530]or continue to empower the learner.
[00:46:59.120]We've already started empowering the learner.
[00:47:01.080]But the next step of empowerment,
[00:47:03.340]and maybe a little bit of undoing,
[00:47:05.930]is to teach the child and to teach the individual,
[00:47:09.460]you don't have to go to the highest escalation point
[00:47:12.910]for me to listen.
[00:47:14.240]I will listen at the first sign
[00:47:17.170]that you don't like something.
[00:47:19.020]So, that's where we wanna start.
[00:47:20.690]And teach the child as we slowly progress the expectation.
[00:47:24.910]Maybe you come to interrupt.
[00:47:26.510]Maybe you ask the child to turn down the music a little bit.
[00:47:30.110]You do something.
[00:47:30.970]These are the triggers that we've identified.
[00:47:33.330]The challenging context we've identified
[00:47:35.710]are ecologically valid
[00:47:36.990]or what is expected of that individual
[00:47:39.650]in whatever context, problem behaviors,
[00:47:41.620]typically experience.
[00:47:42.700]So, mom and teachers and dads,
[00:47:45.010]I'm sorry, I don't mean to be exclude excluding dads here,
[00:47:48.350]tell us this is what I want him to do this
[00:47:51.377]or this is the context.
[00:47:52.643]This is what it looks like.
[00:47:53.770]His brother wants to do X.
[00:47:56.080]We wanna go out the door.
[00:47:57.330]He needs to put his shoes on.
[00:47:59.020]We gotta do some math.
[00:48:00.060]Whatever the case may be.
[00:48:01.810]And we start to slowly present that context.
[00:48:05.380]And we go about it a lot more gently.
[00:48:09.200]I'm sad to say there are some videos of me
[00:48:10.900]on the practical functional assessment website
[00:48:14.800]where I'm doing analyses.
[00:48:15.920]This is when I didn't know better.
[00:48:19.140]And a child is playing with his iPad
[00:48:24.270]and I come to present one of these challenging contexts.
[00:48:27.210]And I just go okay, we're all done with that.
[00:48:31.340]It is ugly. It's awful.
[00:48:34.770]You won't even know what happened to you
[00:48:36.520]if I did that to you.
[00:48:37.780]You'd just be like stunned.
[00:48:39.280]And then, we're surprised
[00:48:40.310]that sometimes we would get the highest level of aggression
[00:48:43.330]or self-injury.
[00:48:44.950]Now, we're saying hey, there's no need.
[00:48:46.900]Remember, I said just the act of engaging
[00:48:50.410]in severe problem behavior is a traumatic event.
[00:48:52.630]And the last thing we wanna do is retraumatize the child.
[00:48:55.440]So, how about we go gentle? We go slow.
[00:48:58.540]You can signal you're about to take the tablet away
[00:49:00.870]before you take it away.
[00:49:02.840]And we do that.
[00:49:03.673]And at first, it looks a little bit funny
[00:49:05.120]because we're trying to exaggerate it.
[00:49:06.560]So, we might stand up and be like,
[00:49:08.130]and this is actually from teachers.
[00:49:09.710]Now, there are a lot of teachers here
[00:49:10.790]so maybe you guys can tell me if we're wrong.
[00:49:12.770]We thought teachers often put their hands together
[00:49:15.430]when they're about to instruct the class.
[00:49:16.960]Is that true?
[00:49:17.840]Or did we make that up?
[00:49:20.130]Do you guys do this?
[00:49:21.186](Mahshid clapping)
[00:49:22.280]Hey, guys.
[00:49:25.300]Maybe just the teachers we saw.
[00:49:27.260]So now, we do that
[00:49:29.036]but we've exaggerated a bit.
[00:49:31.380]Again, because we wanna really clearly signal
[00:49:33.430]I'm about to do something different.
[00:49:35.780]So, we take the posture of supervision,
[00:49:38.320]take the posture that you normally take
[00:49:40.360]when you're interrupting kids
[00:49:41.860]or when you're interrupting somebody.
[00:49:43.210]And we go okay, it's time to do something else.
[00:49:47.190]We do a little signal.
[00:49:50.280]And when we do that, a lot of times,
[00:49:53.480]we get a little bit of a mild display of displeasure
[00:49:58.370]from the child.
[00:49:59.470]They might be like no, no, no, no.
[00:50:01.210]They might turtle away from you.
[00:50:02.900]Kids become very protective of their stuff
[00:50:04.840]when they don't wanna give it away,
[00:50:05.830]when they realize,
[00:50:06.663]"Ah, you're about to come and take this away."
[00:50:08.850]And here's the thing, we can empower that.
[00:50:12.330]You don't have to wait for the punch.
[00:50:15.240]I hope you don't.
[00:50:16.600]I hope we never do again.
[00:50:18.750]I hope we recognize
[00:50:19.900]you really don't wanna give your tablet away to me.
[00:50:21.940]Okay, I see that.
[00:50:23.160]And we can agree on that.
[00:50:24.680]Two people can watch and be like yep,
[00:50:26.220]as soon as you approach him, he went.
[00:50:28.910]So, do I really need to push any more than that?
[00:50:32.210]And the answer for us, at least in the assessment,
[00:50:34.680]certainly is no.
[00:50:36.510]It's clear to us that that's what's happening.
[00:50:39.370]So, we try and identify these mild behaviors
[00:50:43.560]and really have two categories of behavior,
[00:50:45.550]severe problem behavior and mild problem behavior.
[00:50:48.620]And we distinguish between the two
[00:50:50.470]by saying severe will hurt you or them, destroy things.
[00:50:55.380]And mild does not, but they usually go occur.
[00:50:58.520]They usually come before.
[00:50:59.930]Not every time.
[00:51:01.170]And mild doesn't always go to severe,
[00:51:03.470]but it's a pretty good indication
[00:51:04.750]that the child's not happy with what's about to happen.
[00:51:07.640]And sometimes even if there is a clear affect change.
[00:51:11.010]The child might be smiling, super happy,
[00:51:13.310]talking to you, hanging out, having a grand old time.
[00:51:16.220]And then, you come to do something
[00:51:17.890]and they're like.
[00:51:19.580]We can respond to that as well.
[00:51:21.380]That is an indication. You're communicating.
[00:51:23.380]Those are all attempts to communicate
[00:51:25.380]and say I don't like what's about to happen.
[00:51:28.020]And we're saying, let's take it all.
[00:51:30.490]That's how we increase safety.
[00:51:31.720]That's how we empower the individual.
[00:51:37.700]And so, we reinforced.
[00:51:38.980]Originally in the assessment,
[00:51:40.390]again, we're just trying to test here.
[00:51:42.850]We're trying to test what mom and teachers and dads
[00:51:46.740]describe to us as why problem behavior happens.
[00:51:49.530]And at this first step is for us to say
[00:51:51.330]okay, let's first make sure we can get HRE.
[00:51:54.060]We can create a context
[00:51:54.893]that the child's not engaging in problem behavior.
[00:51:57.480]Then, let's very gently and gradually
[00:52:01.330]present some of those triggers
[00:52:02.730]that caregivers said matter and/or difficult.
[00:52:07.570]As soon as there isn't a display of,
[00:52:09.777]"Yeah, I don't like it,"
[00:52:11.740]go back to HRE.
[00:52:14.200]The assessment can be very, very safe.
[00:52:17.930]Awesome.
[00:52:18.830]People can out of that assessment and say,
[00:52:20.777]"That was great."
[00:52:22.430]In fact, sometimes when we end the assessment,
[00:52:24.057]the kid might not wanna leave.
[00:52:25.870]They're like, "No, I wanna keep doing this."
[00:52:28.700]But then the next step,
[00:52:31.010]which is in the treatment part
[00:52:33.430]is we gotta move the beyond that.
[00:52:35.480]Because those triggers are going to happen.
[00:52:37.430]We can't always go back to HRE. That's just not life.
[00:52:41.000]So now, it's about teaching those skills.
[00:52:43.020]But we do those teaching moments just as gently
[00:52:46.120]and just as peacefully.
[00:52:47.360]And we really wanna be just as responsive
[00:52:50.100]to the child's behaviors as they are challenged
[00:52:54.930]to do more difficult things.
[00:52:56.370]And the first three things we think
[00:52:59.500]every individual needs to learn
[00:53:03.300]is communication, toleration, and cooperation.
[00:53:08.490]Basically one, you have to be able
[00:53:11.740]to very clearly tell people around you
[00:53:16.200]that you don't like what's about to happen.
[00:53:18.020]Not everyone's gonna read your expression.
[00:53:20.770]Not everyone's gonna read the turtling.
[00:53:22.580]Not everyone's gonna respond to some of the other behaviors.
[00:53:26.550]So communicating more effectively,
[00:53:28.860]especially in the typical environment,
[00:53:30.490]where in the assessment, it's easy for us.
[00:53:32.650]We're setting it up.
[00:53:33.660]We know that we just presented a trigger.
[00:53:35.950]Whereas in the real world,
[00:53:38.300]people may not know that they just presented a trigger.
[00:53:40.580]So, they also don't know like,
[00:53:41.787]"Why are you upset?
[00:53:42.620]I don't know what you want."
[00:53:43.670]So, the first step is to communicate.
[00:53:45.790]To teach a child to more clearly say,
[00:53:48.467]"Here's what I need."
[00:53:49.920]Now, some of our students
[00:53:52.200]have extensive communication needs.
[00:53:54.560]I know that you guys might be working on PECS,
[00:53:57.220]might be working on vocal verbal language,
[00:53:59.870]and teaching specific responses and/or signs.
[00:54:05.070]So, there might be a huge curriculum of language
[00:54:09.470]that you need to work on
[00:54:10.470]and communication that you need work on.
[00:54:12.140]But as a first step, what we're suggesting is this.
[00:54:15.340]Right now, what may be happening,
[00:54:17.330]even if you have a PECS book,
[00:54:18.640]even if you have Proloquo,
[00:54:20.240]even if you have those signs,
[00:54:22.020]the child first engages in a problematic behavior
[00:54:26.780]that prompts those around the child to say,
[00:54:29.787]"Okay, what do you want Mahshid? Here's your PECS book.
[00:54:33.860]Now, tell me what you want."
[00:54:35.430]And what we're saying how about we just replace
[00:54:37.730]that problem behavior with the general
[00:54:40.900]a general form of communication
[00:54:42.890]that can serve as basically gaining attention.
[00:54:46.040]That says I need something.
[00:54:48.310]Things are not going the way I like.
[00:54:50.530]And then, you can still come in with that PECS book,
[00:54:53.130]with the gestures, with the vocal verbal specific language,
[00:54:56.630]and get that specific communication.
[00:54:59.410]But in the moment, the child is upset
[00:55:01.160]and they're not engaging in communication.
[00:55:03.830]It's too much to ask for them to be very specific.
[00:55:08.130]As a first step, what we want for them to do is simply
[00:55:10.920]at least not engage in problem behavior
[00:55:12.490]and give us a general appropriate communication response
[00:55:17.390]that others will respect and respond to.
[00:55:21.730]We're always thinking about novel individuals
[00:55:24.720]that the child might come in contact with.
[00:55:29.250]I worked with one of my colleagues in Pacific.
[00:55:34.950]He doesn't really work with kids as a behavior analyst,
[00:55:36.940]but more of a translational basic behavior analyst.
[00:55:40.690]So, he doesn't have children.
[00:55:41.890]He doesn't work with children.
[00:55:42.800]He doesn't like children.
[00:55:44.830]Those are his words.
[00:55:46.210]And he said,
[00:55:49.317]"You know, if I was at at a coffee shop,
[00:55:53.080]and I normally go to a coffee shop
[00:55:54.670]because I figure I'm away from kids there,
[00:56:00.090]but if a little kid came up to me and said,
[00:56:01.970]'Excuse me, Matt. Can I have your watch?'
[00:56:05.830]I would probably give it to him 'cause he asked so nicely."
[00:56:10.000]So we do sometimes think about,
[00:56:12.680]obviously to the extent possible,
[00:56:14.490]depending on the modality of communication
[00:56:16.700]that's appropriate for your learner,
[00:56:18.370]also thinking about a communication response,
[00:56:20.610]that initial communication response
[00:56:22.560]that other novel people would be like,
[00:56:24.557]"Oh sure, you need something. What can I do for you?"
[00:56:27.930]Not just the people that are the child's people.
[00:56:33.110]But that's the first step.
[00:56:34.090]And then, the second step is sometimes
[00:56:36.990]even though you're super polite
[00:56:38.540]and you might ask Matt for his watch,
[00:56:40.290]he might say, "No, I'm sorry," or "Not right now,"
[00:56:44.560]or "Wait," or "In a second."
[00:56:46.330]There's some sort of disappointing cue.
[00:56:49.157]And for a lot of our learners,
[00:56:50.260]those disappointing cues obviously have a history.
[00:56:53.710]And so, there could be an impulsive problematic behavior
[00:56:57.440]to that.
[00:56:58.420]There's a quick sort of emotional response to it.
[00:57:01.810]So, one of the things we want children to get used to
[00:57:05.270]is to hear the word, no, not right now.
[00:57:09.030]And this is true for all kids and really for all people.
[00:57:12.120]That sometimes you hear the word no
[00:57:14.660]and you still have to keep your cool.
[00:57:18.600]And so, that would be the next step
[00:57:20.620]of just simply tolerating, hearing those cues
[00:57:23.810]and not having a quick emotional response to it.
[00:57:27.200]And then, the next thing really is cooperation.
[00:57:32.040]And cooperation with three very important things.
[00:57:35.920]One, to stop and give up
[00:57:39.840]what you are doing.
[00:57:42.360]At any point you interrupt the child,
[00:57:43.880]you interrupt what they're are doing to do something.
[00:57:47.140]They were doing something already.
[00:57:49.130]Even if they were sitting and lounging on a couch,
[00:57:51.960]that's what they were doing.
[00:57:53.010]If they were engaging in stereotypy,
[00:57:54.600]that's what they were doing.
[00:57:55.940]If they were on their iPad, that's what they're doing.
[00:57:58.060]So before they can do what you want,
[00:58:00.700]they gotta learn to give up whatever it was
[00:58:02.810]that they were doing.
[00:58:03.643]And that's a skill.
[00:58:05.350]That's something that they need to learn to cooperate with.
[00:58:07.810]And we can't sort of rush them through that.
[00:58:09.730]And that's what I mean by it needs to be gradual.
[00:58:11.950]It needs to be gentle.
[00:58:13.670]We gotta start with that.
[00:58:15.710]And here's the thing.
[00:58:17.540]The reason it's so emotional and difficult,
[00:58:20.030]it could also be that there is this long history
[00:58:22.640]of every time Mahshid comes over
[00:58:24.900]and tells me to give a up my tablet,
[00:58:26.480]my tablet goes away for a very long time.
[00:58:30.210]So, they're responding
[00:58:31.230]to that historical sort of experience
[00:58:33.610]of like this is gonna take a long time before I get it back.
[00:58:36.650]And we wanna override that a little bit and say,
[00:58:39.297]"Every time I interrupt you
[00:58:40.410]and I ask you to do something and give your stuff up,
[00:58:42.320]it's not gonna be a really long delay
[00:58:44.410]before you can go back to your way."
[00:58:46.780]And if we do that, if we teach a child
[00:58:48.820]that it's not so hot all the time,
[00:58:51.370]they learn to cooperate better
[00:58:53.220]and we surprise them by giving it back to them
[00:58:56.470]at various points.
[00:58:59.160]And then, the next thing you gotta do,
[00:59:00.470]probably you gotta transition from your activity
[00:59:03.180]to now the new activity and be ready to learn.
[00:59:06.730]Now, that might mean a physical transition
[00:59:09.980]or simply orient from one thing to another,
[00:59:14.440]orient to the teacher
[00:59:15.430]and look at what they're asking you to do.
[00:59:16.657]But you gotta do that
[00:59:18.280]before you can listen to the next set of instruction.
[00:59:21.960]And then, of course, the specific instructions might follow.
[00:59:26.730]But I see our job, the behavioral team's job,
[00:59:30.820]not so much to teach every single skill
[00:59:35.700]and target language target, math target,
[00:59:39.350]science target, social target that the child needs to learn.
[00:59:42.760]Our kids are in school
[00:59:44.080]and they probably have to be in school for like 12 years,
[00:59:46.220]and really life and learning continues.
[00:59:49.830]What we're trying to do here
[00:59:51.870]is to teach a child to tolerate a teaching context
[00:59:57.330]or to tolerate a context in which they just gotta go along
[01:00:00.980]with someone else's preference.
[01:00:02.850]If you can do that,
[01:00:04.460]if you can be interrupted
[01:00:07.420]and you know how to communicate not to be interrupted,
[01:00:10.260]but then you can also tolerate denial of that communication
[01:00:15.010]and you can give up your stuff,
[01:00:16.930]and you can go along with someone else's preferences
[01:00:19.090]and get ready to learn,
[01:00:20.680]now the door's really open.
[01:00:23.010]Now, anybody can teach that child.
[01:00:25.580]And actually, there are teachers
[01:00:26.710]that are way better than us, behavior analysts,
[01:00:30.580]in figuring out how to teach the specific responses.
[01:00:33.680]You might have a speech pathologist,
[01:00:35.220]who's the expert really on teaching vocal verbal sounds.
[01:00:39.180]And so, that's the person that needs to come in and teach.
[01:00:42.180]All we need to do is to teach the child
[01:00:44.990]to tolerate that session.
[01:00:48.150]To be able to give up their stuff
[01:00:51.200]and go along with someone else's expectations for a while.
[01:00:55.367]And we really wanna do this,
[01:00:58.170]not by relying on extinction or punishment.
[01:01:01.610]Now, extinction is always a part of any treatment
[01:01:05.110]that you do.
[01:01:05.943]The problem was that it was really the driver.
[01:01:09.670]It was the thing that
[01:01:14.330]we relied on the most.
[01:01:16.210]It was always problem behavior was on extinction
[01:01:18.170]as soon as you started your treatment.
[01:01:19.740]And now, the only way to get back to the reinforcement
[01:01:23.410]was to engage in the behaviors we wanted to.
[01:01:25.460]And we were pretty set in that.
[01:01:26.457]It was a procedural sort of integrity thing
[01:01:29.450]that that needs to happen.
[01:01:31.640]That problem behavior can no longer work.
[01:01:34.940]And what we're saying now
[01:01:36.130]is we don't need to be so harsh with that.
[01:01:39.020]'Cause here's the thing,
[01:01:40.320]problem behavior is still the prevalent.
[01:01:42.960]It's the thing that at strength for that child.
[01:01:45.220]And there's still a lot of emotional responding
[01:01:47.700]because these are difficult things
[01:01:49.100]that you're asking the child to do.
[01:01:50.450]And we can be a little bit more empathetic.
[01:01:53.350]We can understand a little bit more.
[01:01:54.850]We can respond to those behaviors a lot more.
[01:01:57.230]At the very least, we don't have to pretend
[01:01:59.980]like they didn't happen.
[01:02:01.550]We can acknowledge it.
[01:02:02.560]We can acknowledge that the child's finding it difficult.
[01:02:05.810]So, we're saying let's not worry so much
[01:02:08.560]about extinction and punishment.
[01:02:09.900]Instead, let's really focus
[01:02:11.960]on really effective prompting
[01:02:14.480]and differential reinforcement.
[01:02:16.890]There's obviously differential consequences.
[01:02:18.780]There to be differential consequences.
[01:02:21.040]But there is a way to do extinction that's televisable.
[01:02:24.310]That you wouldn't be embarrassed
[01:02:25.550]if it was on the six o'clock news
[01:02:26.960]that you were behaving that way with a child
[01:02:30.478](static drowns out speaker) another individual.
[01:02:33.210]And there is a way to make it super ugly.
[01:02:36.370]Anything we do, you get up in the morning,
[01:02:38.360]you decide whether you coming to this talk right now or not,
[01:02:41.840]are you gonna sit at Starbucks or not.
[01:02:43.249]None of these ladies are coming to Starbucks
[01:02:46.670]and dragging you in here and saying,
[01:02:48.217]"Okay, Mahshid's talks about to start.
[01:02:49.940]Let's go. Here's how you go there."
[01:02:51.700]And then, kind of physically managing you to come here.
[01:02:54.660]However, there are some severe consequences
[01:02:57.760]for missing this amazing talk.
[01:03:01.410]But there are, there are differential consequences.
[01:03:03.750]You get to sit down at Starbucks and enjoy your coffee
[01:03:06.260]in a maybe a more peaceful way
[01:03:09.000]or you get to come here
[01:03:10.870]and hopefully have some other reinforcers delivered
[01:03:13.370]and not just punishment.
[01:03:14.580]Or maybe you are avoiding a little bit of punishment too,
[01:03:17.520]but it's negative punishment and not positive punishment.
[01:03:20.820]So, there are obviously incentives and rewards
[01:03:23.660]and differential consequences,
[01:03:24.920]depending on which option you choose.
[01:03:27.070]And I'm not suggesting that we don't have that for kids.
[01:03:31.130]There needs to be a difference
[01:03:32.360]between doing this versus doing that.
[01:03:34.480]But what I'm saying is let's not have extinction
[01:03:37.250]and punishment drive that bus.
[01:03:40.320]And this is how we give choice and control back.
[01:03:45.330]The child is again empowered
[01:03:46.860]by deciding which consequence do they wanna go to.
[01:03:50.320]They can still engage in problem behavior
[01:03:52.090]and they'll get a differential consequence for that.
[01:03:55.300]That's not simply lack of any reinforcement.
[01:03:59.370]But there might be some differences in the quality
[01:04:02.660]and the type of reinforcers that are available.
[01:04:05.680]What we have moved away from quite a bit though
[01:04:07.740]is any kind of physical prompting.
[01:04:11.890]And I don't mean physical prompting as in physical guidance
[01:04:15.570]that you might be giving somebody
[01:04:16.690]who's willingly allowing you
[01:04:18.460]to physically guide them do something.
[01:04:20.270]Let's say, I wanna go learn golf.
[01:04:22.440]Probably, the instructor's gonna come up and say,
[01:04:24.407]"Okay, I'm gonna touch your arm
[01:04:26.520]and I'm gonna move it this way."
[01:04:28.170]Nope, they tell you.
[01:04:29.700]They warn you.
[01:04:30.533]They tell you what they're about to do,
[01:04:31.680]ask you if it's okay, and then they do it.
[01:04:34.210]And you're not resisting it.
[01:04:35.820]When he comes to move my arm
[01:04:36.860]to show me to do something and I guess it's this way,
[01:04:39.050]I won't be like fighting him to do it.
[01:04:42.380]If I was fighting, he'd probably back right off and be like,
[01:04:45.197]"Okay, I'm sorry.
[01:04:46.030]I guess you didn't want me to touch you."
[01:04:47.850]So, I'm not talking about that.
[01:04:48.830]We certainly have instances,
[01:04:50.650]certain skills that we wanna teach
[01:04:51.980]where we gotta help our learners
[01:04:53.900]and we might be physically guiding them.
[01:04:56.310]But what I'm saying is you can do this whole process.
[01:04:58.560]You can teach these skills.
[01:04:59.710]You can get the kids to meaningful outcomes
[01:05:02.260]without forcing them through physical management.
[01:05:06.980]And that's really the traumatic experience
[01:05:08.860]I want us to move away from with our procedures.
[01:05:11.420]That was the classical sort of escape extinction
[01:05:14.270]that I'm saying we don't need to do anymore.
[01:05:16.890]There is still some escape extinction.
[01:05:18.490]You can do it with a televisable approach.
[01:05:24.090]There might be, for example, with my three-year-old,
[01:05:27.640]who's four almost.
[01:05:31.340]There might be a consequence for not brushing her teeth.
[01:05:36.670]She really wants to have some tablet time before bed
[01:05:39.660]and that is contingent on brushing her teeth.
[01:05:41.930]And she gets to choose whether she wants to do herself
[01:05:44.300]or if she wants my help or my husband's help.
[01:05:47.520]And there is some escape extinction
[01:05:50.670]in the sense that if she doesn't do that,
[01:05:55.830]we might still try and not remove the demand a little bit.
[01:06:00.190]But nobody is holding her
[01:06:02.960]and putting a toothbrush in her mouth.
[01:06:04.950]Nobody. Nobody's doing that.
[01:06:06.650]She gets to escape it ultimately, if she really wants to.
[01:06:09.710]We might encourage her.
[01:06:11.190]We might talk about germs.
[01:06:12.210]She's really, really fascinated
[01:06:14.150]by death and germs these days.
[01:06:16.010]Is that normal for a four-year-old?
[01:06:17.830]Please say yes.
[01:06:19.980]And so, we talk about that.
[01:06:23.380]She wants to talk.
[01:06:24.624]And there is some escape
[01:06:27.210]in the sense that maybe this toothbrushing
[01:06:31.730]is now taking a half an hour as opposed to five minutes.
[01:06:34.890]And we have to be patient and we have to be gentle,
[01:06:37.750]and we have to let her do it at her pace.
[01:06:41.990]But I think it's worth it.
[01:06:44.010]I don't think toothbrushing
[01:06:45.373]is worth the traumatic experience
[01:06:48.380]of someone putting something in her mouth against her will.
[01:06:51.200]I just don't think it's worth whatever benefits
[01:06:53.950]we think is gonna come out of brushing her teeth.
[01:06:56.080]And that's what I want us to recognize.
[01:06:58.260]So, we really want to make progress
[01:06:59.870]but we wanna do so in a peaceful way.
[01:07:01.760]And I think it's possible.
[01:07:03.160]We have some data suggesting that it is possible
[01:07:05.360]and we've been able to do it.
[01:07:07.050]It's slower and it's more gentle, and that's okay.
[01:07:11.570]I think it will be more effective long-term.
[01:07:14.690]And of course, once you get there,
[01:07:16.750]then now you can do all of the other assessing
[01:07:18.800]and teaching that you wanted to do,
[01:07:20.000]if you had those developmental assessments you needed to do,
[01:07:23.510]able assessments, maybe math assessments,
[01:07:25.580]whatever you guys are using.
[01:07:27.250]Or you're a teacher and you're really trying to teach,
[01:07:30.520]now, you can introduce those targets.
[01:07:33.030]But you're gonna continue to respond
[01:07:36.370]to your student's response to those attempts to teach.
[01:07:40.230]And there might be new triggers that we identify.
[01:07:42.500]And this is really a set of skills that continue for life.
[01:07:48.260]There are triggers in my day, every day,
[01:07:51.040]and sometimes I don't behave very nicely.
[01:07:54.040]And then, other times I kind of have to remind myself
[01:07:56.280]okay, the first step is I gotta communicate.
[01:07:58.580]The second step is I gotta tolerate it a little bit.
[01:08:01.140]And then, you might ask for some help.
[01:08:03.280]Maybe make it a little bit easier.
[01:08:04.920]Maybe that's what we gotta do.
[01:08:06.350]Maybe the lesson is too hard.
[01:08:08.370]Maybe we identify some prerequisite skills
[01:08:10.500]that need to be taught first.
[01:08:11.870]And that's so that the process can continue
[01:08:14.890]and it can become a lifestyle.
[01:08:16.500]That that's what you do.
[01:08:17.500]You teach kids always with new triggers,
[01:08:20.010]communicate, tolerate, cooperate,
[01:08:22.940]and then let's really assess why problem behavior happens.
[01:08:28.320]Ultimately, what we really wanna do though in this process,
[01:08:31.210]as we work with parents and teachers,
[01:08:35.090]we wanna move way from this super strict emphasis
[01:08:38.530]on procedures.
[01:08:42.530]Like if this happens, this is what you do.
[01:08:45.480]I think those types of plans have gotten us in trouble
[01:08:49.930]and will continue to get us in trouble.
[01:08:51.890]Instead, what we really wanna do,
[01:08:56.400]that's why, (sniffs)
[01:09:01.410]is we wanna give some flexibility
[01:09:05.050]and some decision making back
[01:09:07.870]to our implementers, to the teachers,
[01:09:09.610]to the parents in the moment.
[01:09:11.680]Now, this might be a little uncomfortable.
[01:09:15.070]A lot of times when I first try this with a team,
[01:09:19.610]the supervisors have a hard time
[01:09:21.410]because we all have issues with control.
[01:09:23.850]We wanna know exactly what you're gonna do in every moment.
[01:09:26.460]And now, I'm saying hey, tell your implementer,
[01:09:28.790]do what they think is best in that moment.
[01:09:31.300]Live to do another trial another day.
[01:09:33.890]That's hard. That's giving up control a little bit.
[01:09:36.560]So, we call this program toleration training.
[01:09:41.190]That's what a lot of people talk about.
[01:09:43.570]And I say, it's not just for the kid, it's for everybody.
[01:09:48.060]You gotta give up some control
[01:09:49.250]because now we don't have these set procedures
[01:09:51.990]that we're asking people to follow.
[01:09:54.330]Instead, what I want you to do
[01:09:57.750]is to teach your students, to teach parents,
[01:10:01.670]to teach everybody that is working with that learner
[01:10:07.550]to put values above procedures.
[01:10:11.410]And the values I want you to emphasize and follow
[01:10:16.110]are the three values of safety, televisibility, and rapport.
[01:10:21.620]So at any given moment, you're like,
[01:10:23.577]"I don't know what to do right now.
[01:10:26.040]I'm supposed to present this demand
[01:10:28.500]and this is what the child is supposed to do."
[01:10:31.853]And the child doesn't do what you think they should do,
[01:10:34.360]and you're worried.
[01:10:35.490]The first thing I want you to ask yourself is,
[01:10:38.800]is there a safety concern?
[01:10:41.440]The safest thing to do in light of problem behavior,
[01:10:45.220]when confronted with problem behaviors
[01:10:46.680]is to reinforce it in that moment.
[01:10:49.260]Do what the child is asking you to do.
[01:10:52.300]Sometimes, I realize that's hard because you may not know.
[01:10:55.860]So, there are definitely the situations
[01:10:57.390]where you might have to do
[01:10:58.223]a little bit of like figuring out.
[01:11:00.080]But certainly if you know
[01:11:02.100]and if it was something you just presented,
[01:11:03.840]it's probably the thing you just presented,
[01:11:04.903]so just remove that.
[01:11:07.560]At least temporarily, at least in that moment.
[01:11:10.390]So, safety first. Do what's safe.
[01:11:14.120]Then, the second thing I want you to think about
[01:11:15.842]is televisibility.
[01:11:17.240]And I think we made up this word too.
[01:11:20.370]And what we mean by that is it can,
[01:11:25.140]I guess, most closely be linked to dignity.
[01:11:29.550]Dignity for your client, first and foremost,
[01:11:32.460]dignity for you, and dignity for the field
[01:11:35.030]and the profession you're in.
[01:11:37.570]So if it was shown again at six o'clock to the whole world,
[01:11:42.650]would you be okay with that?
[01:11:45.116]And then, I want to think about your relationship
[01:11:48.720]with your client, with your student, with your child.
[01:11:51.660]Because a relationship really matters.
[01:11:54.230]And there's a lot of data suggesting
[01:11:56.340]that rapport with the individual
[01:12:00.700]who's trying to teach us
[01:12:02.040]or is our therapist is very important.
[01:12:04.820]It's almost more important
[01:12:07.060]than whatever method of therapy they're doing
[01:12:09.440]and whatever expertise they have.
[01:12:12.260]It's a pretty powerful variable
[01:12:14.560]in whether you can be successful
[01:12:16.870]with the clients and the children that you're working with.
[01:12:19.240]So in that moment,
[01:12:20.160]really think about is this gonna completely destroy
[01:12:22.980]the relationship you just spent time building
[01:12:25.020]or rebuilding or repairing.
[01:12:26.690]If the answer is yes, then don't do it.
[01:12:34.610]Now, when I say values override procedures,
[01:12:38.140]I want you, wanna give you two examples
[01:12:40.170]as to how this might look.
[01:12:42.740]So, let's say a child
[01:12:45.690]is trying to break away from you and run.
[01:12:52.110]You've asked them to do something
[01:12:53.330]and they're like no and they're trying to run away,
[01:12:57.110]get away from your hold.
[01:12:59.010]And you're trying to decide,
[01:12:59.987]"Do I let them or do I hold on?"
[01:13:03.930]And we've all known this
[01:13:05.710]and I think all we're doing now
[01:13:07.744]is giving it a valid place to exist.
[01:13:14.870]If I was to film that and put it on the six o'clock news,
[01:13:18.480]and let's say you held onto that child.
[01:13:20.450]You didn't let go.
[01:13:21.760]It would really matter on the context.
[01:13:26.030]If it was my four-year-old about to run into traffic
[01:13:29.440]and I held on and she was scratching me.
[01:13:31.270]And I didn't care and I held on tighter.
[01:13:32.920]And I didn't let go and it looked very ugly.
[01:13:34.850]I'd probably be the hero mom.
[01:13:37.190]I kept her safe.
[01:13:38.730]Safety won.
[01:13:40.850]By contrast, I was trying to brush her teeth
[01:13:44.090]and I was holding her down and trying to brush her teeth.
[01:13:46.660]and it was the exact, maybe same force even used,
[01:13:51.241]it wouldn't look so good, would it?
[01:13:53.350]So, this is what I mean by it's not about procedures.
[01:13:56.250]It's not about he tries to run, you stop.
[01:13:59.760]He's engaging in self-injury, you hold his hands down.
[01:14:03.210]It really depends on why would he stop engaging
[01:14:06.640]in self-injury if you weren't towering over him?
[01:14:09.660]Then, maybe just move back
[01:14:11.640]as opposed to get closer and get your hands on him.
[01:14:15.260]By contrast, if it was a trigger
[01:14:16.750]you couldn't turn off
[01:14:17.700]and you really needed to keep that kid safe
[01:14:20.290]because he was about to injure his eyes,
[01:14:22.810]then it would be totally okay for you
[01:14:24.390]to get your hands on him, put his hands down,
[01:14:27.000]and maybe hold it down.
[01:14:28.930]So, we're allowing people.
[01:14:30.220]Now, I really think despite what people reported,
[01:14:34.410]what teachers reported, parents reported,
[01:14:36.010]you guys were already doing this.
[01:14:37.630]You guys were already making these really good decisions
[01:14:39.910]in that moment and saying,
[01:14:41.677]"I'm gonna keep this child safe.
[01:14:43.490]This is a person in my care and I'm gonna keep them safe."
[01:14:45.890]But then, maybe you were a little ashamed to admit it to me
[01:14:49.150]because you were like,
[01:14:49.983]"Oh yeah, no, I did this."
[01:14:51.750]And now, I'm saying it's okay.
[01:14:53.680]Let's teach people. Let's celebrate that.
[01:14:56.330]So, when I work with my consultees now
[01:14:58.407]and I work with my teens or parents and I,
[01:15:01.290]and they tell me something happened
[01:15:03.260]and a decision was made,
[01:15:04.470]I'm less interested in what they did
[01:15:07.420]and more interested in why.
[01:15:10.410]What was the rationale you used
[01:15:12.510]when you decided to persist and continue
[01:15:15.040]versus remove the demand.
[01:15:16.150]Let's talk about that.
[01:15:18.930]And if it's situations like toothbrushing,
[01:15:21.820]or math, or whatever, and you decided to remove your demand,
[01:15:24.740]we certainly need to go back and look at, okay,
[01:15:27.390]that can't be a lifestyle
[01:15:28.960]because my daughter does need to brush her teeth.
[01:15:30.910]She needs to learn.
[01:15:31.950]I just need to figure out how to motivate her,
[01:15:34.200]how to make the task less aversive.
[01:15:36.620]I got some work to do.
[01:15:38.710]But in that moment, I don't need to follow through.
[01:15:41.490]It's not worth the traumatic experience
[01:15:44.380]that I'm going to expose her to.
[01:15:45.960]And that's what we're asking.
[01:15:48.070]We're saying let's just have a little bit of humility
[01:15:50.950]and realize that what we're doing
[01:15:53.470]is not effective in that moment,
[01:15:55.050]and it's okay to reinforce problem behavior.
[01:15:58.080]We've all talked about, I think,
[01:15:59.790]the effects of reinforcement
[01:16:02.350]as far as increasing the future probability
[01:16:05.220]of problem behavior happening.
[01:16:06.330]Obviously if you continue to reinforce problem behavior,
[01:16:09.690]it will continue to happen.
[01:16:10.950]It increases this future probability.
[01:16:14.360]But then, the immediate effects of reinforcement
[01:16:17.260]is it turns problem behavior off.
[01:16:19.240]It turns any behavior off.
[01:16:21.640]If you want water, you ask for water,
[01:16:23.260]I deliver water, you're not gonna continue asking.
[01:16:25.990]And so, that is where safety lives in a lot of situations.
[01:16:35.793]I have until 10:30, right?
[01:16:38.322]10.
[01:16:39.190]10, Okay.
[01:16:40.130]I think that's good actually.
[01:16:41.840]I think what we're gonna do,
[01:16:44.150]because I talked about a lot of this,
[01:16:46.350]but I want to review it with you guys
[01:16:52.260]in a written format.
[01:16:53.900]So, just gimme two more minutes.
[01:16:56.750]Everything that I talked about just now
[01:16:59.330]is summarized in this
[01:17:05.460]slide.
[01:17:07.150]Once we get to treatment,
[01:17:10.050]our recommendations for problem behavior
[01:17:12.310]depend on the extent to which it's mild versus severe.
[01:17:17.470]With both behaviors, mild or severe,
[01:17:20.090]what we're saying is please acknowledge
[01:17:22.810]that a problematic behavior just happened.
[01:17:25.840]The child is trying to communicate to you.
[01:17:28.560]They just did something.
[01:17:30.150]Let (static drowns out speaker).
[01:17:33.010]Let's not pretend like that did not happen.
[01:17:36.380]Imagine you're just complaining to your friends
[01:17:38.350]and you tell them about something.
[01:17:39.840]You're not asking for solution.
[01:17:41.730]You just want them to say,
[01:17:42.563]"I'm sorry. That sucks.
[01:17:44.320]That's really hard."
[01:17:46.030]And sometimes, that's what our kids want.
[01:17:47.850]They're doing something tough.
[01:17:48.730]They just want you to say,
[01:17:49.563]"I see you. This is hard."
[01:17:51.730]Okay, so acknowledge it.
[01:17:53.600]You're not gonna make things worse because you've said,
[01:17:56.727]"Hey, I see you. I hear you."
[01:17:59.350]Acknowledge it.
[01:18:01.730]If it's mild, you can certainly encourage persistence.
[01:18:05.320]So if my daughter's saying,
[01:18:06.177]"Ugh, I don't wanna do this."
[01:18:07.830]I might say, come on, let's get the germs.
[01:18:10.390]Let's do a little bit, just do the top ones.
[01:18:13.080]So, we encourage persistence.
[01:18:14.510]We might adjust in that moment
[01:18:16.990]the criteria for reinforcement.
[01:18:18.590]We might say I get a little bit of cooperation with this,
[01:18:20.710]I'm gonna go ahead and reinforce this behavior.
[01:18:23.950]We might give a little bit more time in HRE.
[01:18:26.340]And we might reflect and make that task easier
[01:18:30.260]and make future trials better.
[01:18:32.380]So, we don't have to reinforce mild behaviors
[01:18:34.770]and we don't have to sort of readjust
[01:18:36.900]our reinforcement every time.
[01:18:41.640]By contrast,
[01:18:45.610]if it's severe behavior,
[01:18:46.900]what we're suggesting is go ahead and reinforce it
[01:18:50.640]in that moment.
[01:18:53.040]Just go ahead.
[01:18:53.873]Acknowledge it again and reinforce it.
[01:18:55.450]Just remove the demands.
[01:18:56.640]Don't worry about persisting in any way.
[01:19:00.140]Reinforce it and then do the same thing again.
[01:19:02.460]You gotta reflect.
[01:19:03.370]You gotta figure out why it happened.
[01:19:05.260]We might have to adjust the expectation.
[01:19:07.130]You might have to adjust the way you're teaching it.
[01:19:09.550]So that we're not stuck in a lifestyle
[01:19:13.180]where we're simply reinforce problem behavior.
[01:19:15.120]That can't be what's happening all the time
[01:19:17.570]or you're not gonna get it anywhere.
[01:19:21.250]But it doesn't have to be in that specific moment.
[01:19:36.900]And I think this is the message I'm gonna leave you with.
[01:19:39.320]To think about these three values
[01:19:42.370]and think about incorporating it
[01:19:43.870]and really prioritizing it more than anything else.
[01:19:48.130]If these three values can be relatively respected,
[01:19:53.100]then we can go to our fourth goal, which is to teach.
[01:19:58.340]Thanks, guys.
[01:19:59.332](audience clapping)
[01:20:21.648]♪ It's just another course ♪
[01:20:23.725]♪ Made a meal outta me, and come back for more ♪
[01:20:27.565]♪ Had to cool me down to take another round ♪
[01:20:31.048]♪ Now I'm back in the ring to take another swing ♪
[01:20:34.991]♪ That the walls were shaking, the Earth was quaking ♪
[01:20:38.749]♪ My mind was aching and we were making it ♪
[01:20:42.751]♪ And you shook me all night long ♪
[01:20:49.761]♪ Yeah, you shook me all night long ♪
[01:20:55.975]♪ You shook me ♪
[01:20:59.775]♪ All night long ♪
[01:21:03.840]♪ You had me shaking ♪
[01:21:04.798]♪ And you shook me all night long ♪
[01:21:11.250]♪ Yeah, you shook me ♪
[01:21:14.480]♪ Well, you took me ♪
[01:21:16.034](upbeat music)

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Trauma Informed ABA

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