Trauma Informed Care

What is Trauma-Informed Care in ABA?

Trauma-informed care is an approach for providing therapeutic support that includes an understanding of and responsiveness to the emotional, physical, psychological and behavioral impact of trauma. It recognizes that many of the clients and families we serve and/or interact with have a history of and/or ongoing trauma that influences how they perceive and/or respond to their environment and interactions with others. The environment and interactions with others within and across a variety of settings and/or people can exacerbate the physical, mental and behavioral manifestations of past, present and/or anticipated trauma experiences. The same event and/or experience can be interpreted very differently between different people, often depending upon each individual’s past experiences related to various factors associated with that event/experience. 

What Does Trauma-Informed Care Look Like?

Trauma-Informed Care ensures that supports are provided for all individuals, including those we serve and those with whom we work, so they feel physically and emotionally safe. The physical setting is safe and interactions with others including staff, clients and families, provide psychological and physical safety. Staff members are trained to recognize and anticipate potentially traumatizing situations, setting events and/or reported events that have occurred outside of the immediate current setting (such as another person entering the setting and disturbing the client’s ongoing play or relaxation situation or a previous event at home or in the community) that has the potential to traumatize the client directly and/or indirectly.

Commonly Posed Questions/Comments

My child has never been traumatized. He just has Autism and he can talk and he’s high functioning. 

Adverse childhood experiences are recognized as contributing to trauma. This does not necessarily mean that someone or something purposefully inflicted harm on your child.

 A person’s experience as an individual with Autism, that possibly includes communication challenges, difficulties understanding the complexities and nuances of language and critical information provided through nonverbal communication when speaking, listening and/or observing, often interferes with meeting a child’s physical and/or emotional needs.

Nonverbal and verbal communication are critical for accurate communication, including understanding and using the following:

• implied meaning
• multiple meanings of words/phrases
• intonation
• speed and rhythm of verbalizations and other forms of communication 
• requesting clarification
• appropriately and effectively communicating understanding
• appropriately and effectively requesting additional information to increase understanding

Additionally, anticipation of immediate responses/gratification provided by others creates the conditions for significant and potentially traumatizing effects as a result of failure to having needs met in an adequate and satisfying manner. 

Why does my child who has Autism need Trauma Informed Care? No one has ever tried to hurt him and we don’t punish or scold him.

Trauma-Informed Care actively promotes a sense of psychological and physical safety from the perspective of the individual. It builds and maintains trust with the individual and family members, staff, leadership and other people who have a role in helping the learner trust that consistent safety needs and personal needs will be met, even when events do not occur as preferred and/or anticipated. Individuals who have not developed or do not consistently or effectively implement prosocial behaviors, are unable to independently have their needs for safety met in a socially appropriate manner. Such unmet needs are often pursued in the form of maladaptive behaviors. Trauma-Informed Care is about being able to access and utilize the supports needed to prevent and/or successfully respond to/recover from varying types, forms and severities of stressful/potentially traumatic experiences.

My child just doesn’t want anyone to tell him what to do, when to do something or how to do it. Trauma-Informed Care promotes a sense of control and active engagement. The individual is empowered through meaningful sharing related to decision-making and the capacity to act or do something effectively. When an individual’s needs for control, active engagement and meaningful sharing related to decision-making are met, data often shows a decrease in resistance to cooperation and an increase in compliance, cooperation and successful interaction with others. 

If you leave it up to my child to decide or choose, he will pick whatever he thinks you do not want him to do. This behavior pattern is commonly observed in individuals whose need for independence is not being met. It is important to recognize that the need for independence matches a person’s chronological age, not their functioning age)

Remember the 4 R’s

Realize how trauma affects the individual.

Recognize the symptoms of trauma in individuals served (those symptoms may present differently across different individuals).

Respond to clients and their families in a trauma-informed manner.

Resist re-traumatizing clients.

What is Traumatic Stress?

Traumatic stress is experienced when an individual is unable to recover or feel safe after the body’s Autonomic Nervous System (ANS) is activated. The autonomic nervous system (ANS) is responsible for regulating involuntary bodily functions such as heart rate, digestion, pupillary response and respiratory rate. 

What does the ANS do and what does it have to do with behavior?

The ANS is a component of the nervous system that is responsible for regulating involuntary bodily functions such as heart rate, digestion, respiratory rate and pupillary response.

The ANS consists of the sympathetic and parasympathetic systems. These two systems often work in opposition to maintaining the body’s internal balance (homeostasis). The ANS is part of the peripheral nervous system and controls vital functions such as breathing, heartbeat and digestion.

The ANS is also involved in acute stress response. It works with the endocrine system to prepare the body for “fight or flight”. 

The ANS sends information to and from internal organs such as the lungs and liver. Since it operates automatically, it is considered to not be under voluntary control.

The ANS is believed to be associated with emotions. Studies have shown activation of the ANS was observed when people responded to positive and negative emotions. 

Some of the functions of the ANS include:

∙ Fight or flight response

∙ Regulate heart rate

∙ Regulate blood pressure

∙ Secretion of body fluids (sweat, urine, saliva)

∙ Breathing

∙ Regulating metabolism

∙ Pupillary responses

The parasympathetic nervous system (part of the ANS-autonomic nervous system) is responsible for returning the body to a relaxed and restored state after stress. The parasympathetic nervous system promotes “rest and digest” functions and restores balance and conservation of energy.

The sympathetic nervous system prepares the body for the “fight or flight” response, including increased heart rate, dilation of airways and redirection of blood flow to muscles to prepare the body for immediate action.

What are trauma-informed practices in the provider-client relationship?

Providers need to actively work to understand what types of trauma are present in a client’s unique situation. Trauma may present in the form of anxiety, lack of participation, poor compliance and/or lack of eye contact. To reduce the potential for traumatization or re-traumatization, providers need to 

∙ recognize trauma in clients

∙ build trust and mutual respect

∙ respond to clients in a trauma-informed manner

∙ protect client privacy not only with medical records, but during therapy  

∙ ask/tell client when and why you need to touch them, BEFORE you touch them

∙ remaining at eye level with the client

∙ explaining and asking input re: plan of care/actions related to interventions

∙ minimize distress

∙ maximize autonomy

∙ build rapport

∙ empower clients

∙ ongoing needs assessment for staff, clients and families

∙ ongoing support and resources for staff, clients and families