My name is Jesse Padilla-Goryl. I am a BCBA (Board Certified Behavioral Analyst) working in adult services in rural, Western Colorado with Ariel Clinical Services, an agency that provides therapeutic foster care to youth, and residential, vocational, and therapeutic services to adults with IDD.
In 2021, the Traumatic Stress Institute (TSI) launched a first-of its-kind pilot project to help organizations supporting people with IDD implement trauma-informed care (TIC) not with individuals, not just with clinicians and administrators, but as a whole system. Four organizations from across the US were selected to be part to an 18-month Learning Collaborative (LC) where each organization would implement TSI’s Whole-System Change Model to TIC, but support, collaborate, and share training and coaching with each other as they did so.
One of the IDD organizations was Ariel Clinical Services, a Colorado agency that provides services across the state. Ariel saw this LC as an opportunity to cement, deepen, and embed previous TIC efforts into the very fabric of their organization.
Jesse Padilla-Goryl, the BCBA Program Manager for Ariel, was an essential leader of Ariel’s TIC change effort. As a BCBA leading this initiative, he had a unique and important perspective because ABA has not historically been aligned with or friendly to the tenets of TIC. TIC’s focus on less-observable concepts like attachment, its elevating relationships over techniques, and highlighting past history and root causes did not jibe well with ABA.
TSI asked Jesse to reflect on his experience as a BCBA and a leader of an intensive TIC change process – how do the two worldviews mesh with each other? Can ABA and TIC “play in the same sand box” and, if so, how?
Thanks Jesse for accepting our invitation. We continue his thoughts here:
The Journey Begins
I was first exposed to ABA as a Special Education teacher after a BCBA consultant changed my classroom from a place of trauma for staff and students, to one of fun, engagement, and actual learning. It was that experience that drove me to pursue a career in ABA, with the intent of helping others increase quality of life. I have learned powerful tools as a BCBA, but I have also come to recognize that ABA can, has, and IS causing harm and trauma in some communities. Many in the ABA world are unwilling to listen to this perspective. It is for this reason that I strongly encourage people in the ABA field to consider an approach of listening and working hard to gain a trauma-informed perspective.
I began my journey into TIC 2021, when I took the Risking Connection® course as part of a national TIC learning collaborative for IDD agencies launched by the Traumatic Stress Institute. I will say I am a skeptic of everything – often to my own demise. When I started the training, I approached it defensively, like a “good” BCBA.
One of the modules contrasted the assumptions of a “not trauma-informed” vs. a “trauma-informed” approach. The “not-trauma informed” talked about token economies, behavior plans, contingencies, and more. I remember thinking, “Hey wait a minute, those are evidence-based!” One of the things ABA gets right is our focus on data. And…one of the things ABA gets wrong is our focus on data – that wasn’t a typo; I love data, I love evidence. But most of all, I love people. I think we sometimes forget the “people” aspect in our field and focus too heavily on numerical outcomes. At some point on that first day, l finally let my guard down and began really listening to the material. There were obvious challenges to what I had been taught in my graduate program, but it’s important to challenge our own perspectives from time to time, and as I’ve learned recently there are now those in ABA with data to backup those challenges.
Learning about RICH Relationships
The biggest takeaway for me from Risking Connection is the emphasis on RICH relationships – relationships that embody Respect, Information, Connection, and Hope – and we should focus on these concepts when working to develop all relationships. My BCBA friends are likely asking for an operational definition at this point, but if you need a clearer application to our field, just remember the concept of “pairing”; we know that behavior plans are often worthless without strong rapport. For me, this was one of the most important tenets of Risking Connection. Behavior Analysis tends to break rapport down into a scientific concept with prescribed amounts and data, which can be fine and all, but we don’t spend enough time talking about the HOW of building rapport.
Risking Connection and trauma-informed approaches rely heavily on psychological concepts like attachment, the neurobiology of trauma, and vicarious trauma – things that were not heavily emphasized in my ABA training. As such, it was important for me to listen with an open mind. Evidence is important, but I can listen to another perspective without demanding data before lending an ear. The idea of RICH relationships continues to shape my own behavior and how I approach each individual person I serve. Consideration of individual trauma history also dictates my approach with individuals in services.
Those critical of ABA will argue that it’s impossible to deliver ABA and be person-centered or trauma-informed. Even as a BCBA myself, there are some practices that I agree cannot be implemented while maintaining a trauma-informed approach. This includes the ongoing use of harmful punishers in some facilities, as well as the forced ableism that occurs when a practitioner insists on intervening on harmless “stims” or maintaining eye contact.
Still, if we look at our ethics code, and some of the intentions of our field, I do believe that ABA has the potential to not only be trauma-informed, but also trauma-reducing. As a BCBA, my goal when “treating” behavior is to consider social significance. Cooper et al. (2007, p.16) defines social significance as “...behaviors that improve the day-to-day life experience of the participants and/or affect their significant others (parents, teachers, peers, employers) in such a way that they behave more positively with and toward the participant”. In my opinion, if our work is not wary of the trauma triggers that impact the daily lives of our clients, we are likely not improving their life experience.
Trauma-Assumed Values with Dr. Greg Hanley
One of my most profound moments on my journey to learning about trauma-informed care came while attending a workshop held by Dr. Greg Hanley. Dr. Hanley has decades of experience in ABA. In recent years, Dr. Hanley has worked to create new processes that follow what he calls “trauma-assumed”, that is to ensure the tools and techniques we use are free from frequent traumatic antecedents or triggers.
During the workshop, Dr. Hanley asked the crowd of eager practitioners this question:
“How many of you would consider yourselves to have compassion for the people we serve?”
– (Hanley, COABA Workshop, February 10, 2023)
Naturally, every hand was raised. Dr. Hanley then stated,
“Lower your hand if you’ve ever told a crying child s/he can do what they want after they complete a task.”
Most hands in the room lowered. Dr. Hanley went on to posit that this approach – what we often refer as the “Premack Principle” – is not compassion, nor trauma-informed, especially when the client is clearly expressing themselves with their behavior. I’m fairly certain there were fewer people in the room on day 2.
Dr. Hanley promotes the idea of values over procedures, and the idea that all treatments should promote these three values: “safety, televisibility, and rapport-building”. Televisibility means that you should only do interventions that you would feel comfortable with if they were televised.
During another part of the workshop, Dr. Hanley asked the room to split into two teams. One team would provide an intervention that promotes the above-mentioned three values. The other would provide an intervention that is technically justifiable for ABA but does not promote the three values. Most practitioners in the room worked with children with Autism in contrast to my work with adults with IDD.
What struck me was that nearly every intervention suggested that is technically justifiable by ABA would be considered an actual rights violation in my adult world. To be fair, this is true for most approaches to learning or therapy for children; most teacher or parent interactions with children would likely be considered a violation of rights for an adult. Still, many in the field promote ABA far beyond work with children and adults with autism. How can we grow our services if many of the techniques we use are restrictive or violate rights?
In Conclusion: Change is Possible
In my opinion, ABA can absolutely be trauma-informed, provided those in the field are willing to reflect on practices that have – and continue to – cause harm. Practitioners in the field must be willing to listen, collaborate, yield to others when necessary, and above all else work to form RICH relationships with those who matter most – our clients. We must consider the ongoing practices, such as use of aversives or pushing parent goals that don’t consider the individual. Further, we must be willing to challenge the notion that the end justifies the means.
With researchers like Dr. Hanley and others, and the recent push for quality trauma-informed care from organizations like TSI, I am optimistic that our field can transform to a practice where healing and trauma-reduction is the norm.