Facilitating Greater Understanding of Trauma-Informed Care in Applied Behavior Analysis: An Introduction to the Special Issue

Abstract

Trauma-informed care (TIC) refers to the guiding principles that inform how organizations or individuals arrange services with respect to acknowledging both the prevalence and impact of trauma. Given the elevated risks of trauma in the populations with which many behavior analysts work, clarifying why, how, and if TIC should be incorporated into behavior analytic work seems prudent. Although the core commitments of TIC are inherently aligned with ethical and effective applied behavior analytic practice, there are few exemplars of how TIC can be intentionally incorporated into behavioral assessment and treatment. This special issue is intended to begin to fill that gap, as well as to promote further discussion of the benefits and limitations of TIC in ABA. In this introduction, we review both the prevalence and potential outcomes of trauma, as well as attempting to dispel misconceptions about TIC that appear common among the behavior analytic community. We highlight how the articles in the special issue are important in developing an evidence base for TIC in ABA, as well as suggesting areas for future research.

Many individuals, including those who receive and provide applied behavior analytic (ABA) services, experience potentially traumatic events (e.g., abuse, neglect, witnessing violence) and sometimes, exposure to such events can have lasting adverse effects on an individual’s functioning and mental, physical, social, and emotional well-being (Substance Abuse & Mental Health Service Administration; SAMHSA, 2014). Recently accumulated data have revealed notable and concerning medical and behavioral health outcomes correlated with having experienced multiple potentially traumatic events in childhood (often referred to as adverse childhood experiences [ACEs]1; Felitti et al., 1998). Reviews and analyses summarizing some of these deleterious outcomes have been published in high-impact, public health journals (e.g., Nelson et al., 2020; Oh et al., 2018).

Many of the risks associated with potentially traumatic experiences are relevant to the provision of behavior analytic services. Researchers have found that, regardless of whether exposure to ACEs directly produces stressor-related diagnoses (e.g., posttraumatic stress disorder [PTSD]), individuals who experience four or more ACEs are 32 times as likely to exhibit learning and behavior problems relative to individuals with zero ACEs. For each additional ACE, an individual’s risk of specifically exhibiting dangerous aggression or self-injurious behavior doubles. Individuals with four or more ACEs are 12 times as likely to attempt suicide (Adverse Childhood Experiences [ACES]—The Burke Foundation, n.d.; Felitti et al., 1998; Nelson et al., 2020). Unfortunately, these outcomes impact a large proportion of the human population. Results from multiple studies with heterogeneous samples estimate that approximately 60% to 90% of individuals have been exposed to at least one potentially traumatic event (Centers for Disease Control & Prevention [CDC], 2019; Ogle et al., 2013, 2014). The CDC further estimates approximately 16% of adults have experienced four or more ACEs in childhood. There appears to be consensus among studies examining the prevalence and impact of exposure to potentially traumatic events across the lifespan: the greater the frequency of exposure to ACEs, the greater the associated risks (CDC, 2019; Costello et al., 2002; Nelson et al., 2020; Ogle et al., 2013, 2014).

Individuals from various historically marginalized groups, including but not limited to those (1) with intellectual and developmental disabilities (e.g., autism); (2) from racial and ethnic minority groups; (3) who have experienced foster care or homelessness; and (4) who identify as LGBTQ+, are at a differentially greater risk to be exposed to potentially traumatizing events in childhood or later in life (Berg et al., 2019; Brattström et al., 2015; Comas-Díaz et al., 2019; Kerns et al., 2015; Merrick et al., 2018; Michna et al., 2023; Ogle et al., 2013, 2014). Many of these demographic categories include individuals who are recipients of ABA services. Indeed, the most recent data from the Behavior Analyst Certification Board (BACB) revealed that more than 80% of board certified behavior analysts (BCBAs) primarily serve autistic individuals (BACB, 2024).

It is important to note, however, that not all potentially traumatic events produce posttraumatic stress or the negative health outcomes mentioned above (Ford & Courtois, 2009; Kerns et al., 2015). Whereas some individuals who experience adverse experiences are indeed negatively affected for life, others may not experience any negative symptoms and may instead develop repertoires of resilience or posttraumatic growth (positive changes following exposure to potentially traumatic events; Henson et al., 2021). Further, apart from respondent behavior, behavior analysts would likely agree that there are no events or stimuli that have an inherent, universal function that apply to all behaving organisms. The manner in which we relate to environmental events is selected and shaped at the individual level, so it is commensurate with a behavior analytic perspective to consider that the same potentially traumatic event may be experienced differently across individuals. Therefore, we do not know specifically the types of stimuli or interactions that will produce traumatic stress or other negative health outcomes, for whom, and under what conditions. As such, it may behoove behavior analysts to (1) learn about the nature and scope of traumatic experiences and their relevance to populations we serve; (2) reflect upon the events they arrange for learners to experience and consider the extent to which they could share stimulus properties with known potentially traumatic events; and (3) familiarize themselves with trauma-informed care (TIC) frameworks, which are explicitly intended to minimize possible retraumatization.

The aim of this special issue of Behavior Analysis in Practice is to highlight behavior analytic research that considers the impact of trauma on the conceptualization, delivery, evaluation, and acceptability of behavior analytic assessment and treatment approaches. We invited manuscripts that employed a range of methodologies, noting that flexibility regarding standards for demonstration of experimental control would likely be warranted for some investigations. We received 16 submissions, all of which were peer reviewed, and ultimately 5 were accepted for publication.2 In this introduction to the special issue, we aim to define TIC by highlighting both what it is and what it is not. We also address some of the misconceptions about TIC, specifically as they pertain to ABA. In doing so, we cite the relevant literature and refer the reader to specific articles found in this special issue that relate to these issues.

Trauma-Informed Care: What It Is and What It Is Not

Given the prevalence of trauma across the general and special populations, many organizations have outlined core values of or commitments to TIC. Although there may be slight variations among different entities (e.g., Centers for Disease Control & Prevention, Substance Abuse & Mental Health Services Administration, Institute on Trauma and Trauma-informed Care; see also Rajaraman et al., 2022), all are inclusive of the notion of providing safe and empowering environments that maximize opportunities for choice and acknowledge potential trauma histories in the individuals they serve. Adherence to these principles is aimed at arranging environments that are unlikely to worsen the symptoms of trauma (i.e., retraumatization) and instead support recovery. Organizations that embrace TIC have policies and procedures that apply to all clients or consumers, regardless of their history or exposure to traumatic events. This is essential, because part of acknowledging trauma and its impact is recognizing that histories may not (or cannot) be known to us.

Behavior analysts familiar with positive behavior interventions and supports (PBIS; Carr et al., 2002; Sugai & Horner, 2014) or multitiered systems of support in general (Benner et al., 2013; Stoiber & Gettinger, 2015) might conceptualize TIC as a Tier 1 intervention, whereby strategies aligned with TIC commitments are implemented across all settings and all individuals within an organization. When implementing TIC as Tier 1, the focus is on employing a collaborative service delivery model and designing a supportive environment that not only acknowledges the impact trauma might have on behavior, but also promotes safety, trust, choice, and skill building (e.g., National Child Traumatic Stress Network [NCTSN] Schools Committee, 2017; Rajaraman et al., 2022). Harris and Fallot (2001) asserted being trauma informed means knowing the trauma history of the learner; however, knowledge of specific trauma histories is not required to align one’s services with TIC at Tier 1 (in school-based TIC frameworks, screening for potential traumatic stressors occurs by trained professionals at Tier 2; NCTSN, 2017).In this special issue, Christopher Seel and colleagues provide an excellent example of how TIC was incorporated into a Tier 1 environmental enrichment intervention in a prison. Prisoners tend to have proportionally higher exposure to traumatic events than the general population (Angelakis et al., 2020); thus, building a trauma-informed Tier 1 intervention could provide a therapeutic environment for incarcerated people, even without knowledge of individual histories of trauma.

Although TIC commitments and their related practices are intended to provide an environment that is supportive of recovery, they are not necessarily intended to facilitate recovery. Individuals whose trauma-related behaviors interfere with their everyday functioning and access to important reinforcers likely will need therapies that are more focused on individual circumstances to promote recovery. In a multitiered model of intervention, these therapies are considered Tier 3, whereby individualized assessment—including gathering details about the individual’s trauma history—informs intervention design and delivery. These strategies, which may include therapies such as trauma-focused cognitive behavior therapy (CBT; Cohen et al., 2016, 2000; Hoover et al., 2024) or acceptance and commitment therapy (ACT; Orsillo & Batten, 2005) among others, are collectively referred to a “trauma-specific therapies.” Organizations or individuals who provide these types of therapeutic services likely take a TIC approach alongside the delivery of strategies aimed at processing traumatic events and improving overall functioning. In this issue, Rachel Rees and her colleagues demonstrate how TIC can be incorporated into established skill-building programs (i.e., Preschool Life Skills; Hanley et al., 2007) to further support children who are receiving a range of services, including trauma-specific therapy.

It is important to note that TIC, unlike trauma-specific services, does not imply a specific set of procedures but rather a set of guiding values or commitments for how services are delivered. In other words, behavior analysts can align their services with TIC by designing services that acknowledge the impact of trauma, foster safety and trust, promote choice and shared governance, and focus on skill building. Several of the articles in this special issue include tables outlining how specific aspects of behavior analytic service delivery align with these commitments. Further, Marney Pollack and colleagues demonstrate the range of behavior analytic assessment and intervention strategies that could be considered “trauma-informed” when working with children with emotional and behavioral disorders, regardless of whether educators are aware of those children’s specific circumstances.

Although it may be intuitively appealing to categorize some strategies as being misaligned with TIC, we would caution against that stance for at least two reasons. First, there is emerging evidence that strategies that appear less aligned with trauma-informed care at first glance can be delivered in ways that are compassionate, socially acceptable, and effective (e.g., kind extinction; Tarbox et al., 2023). Further, giving individuals an opportunity to choose or opt out of the strategies we recommend (e.g., Staubitz et al., 2022) also provides some modicum of assurance that we are not subjecting people to procedures they perceive as harmful or highly aversive. Second, without more systematic evaluation of effects and side-effects of intervention, categorically dismissing some procedures as trauma-inducing could result in disregarding potentially effective strategies that could benefit those we hope to serve. Several of the articles in this special issue are focused on evaluating and refining procedures grounded in behavior analytic principles, while explicitly demonstrating how those procedures align with a clearly defined TIC framework. For example, Joshua Jessel and his colleagues show how functional analysis procedures can be designed to promote physical and emotional safety by limiting exposure to events that might be associated with trauma. This and other studies in this issue provide compelling models of how ABA procedures aligned with TIC commitments might look, as well as the range of direct and indirect measures that help provide a more complete picture of the effects of those procedures on the individuals receiving support. Broadening our scope of measures beyond the immediate target of behavior change is likely an important step in advancing a research and clinical agenda for evaluating TIC effects in behavior analysis, and we will return to this issue in the section on research below.

Dispelling Misconceptions about TIC

The notion of incorporating TIC into behavior analytic practice has been the topic of a number of recent behavior analytic conference presentations, podcasts, and social media posts. Scholarly discussion about the value and process of TIC in behavior analysis is a healthy endeavor that is potentially good for behavior analytic science and practice. Unfortunately, these discussions have also germinated a range of misconceptions about TIC. Addressing these issues is important to clarifying TIC for the field of behavior analysis, so that individuals and organizations can make informed decisions about how or if they will engage with TIC.

Misconception: TIC Requires Appealing Primarily or Exclusively to Remote Events

Aligning behavior analytic services with TIC does not require or even suggest that behavior analysts focus solely or primarily on remote and potentially unverifiable events. As discussed above, when we align behavior analytic services with TIC, we acknowledge the possibility that any person could have experienced adverse events given prevalence estimates in general and special populations, and therefore, we create supportive environments that align with TIC commitments for all. In arranging these environments, we acknowledge the current environment may include stimuli that share stimulus properties with past learning experiences and hence might evoke behavior learned under those past conditions. In other words, we acknowledge a client’s history of operant and respondent conditioning might have included adverse events (Friman & Dymond, 2020) and consider that possibility when building supportive and safe environments. It is important to note that a TIC approach does not assume all clients have experienced traumatic events; instead, it acknowledges the possibility that any client could have experienced an adverse event that might be important in understanding current behavior. Thus, it requires professionals to consider whether their current procedures could mimic commonly experienced adverse events. In other words, embracing TIC means evaluating the present environment with a heightened sensitivity to how current stimuli or events may relate to remote, adverse experiences. Focusing on remote events to the exclusion of immediate contingencies is not only inconsistent with ethical behavior analytic practice (BACB, 2020) and antithetical to the science of behavior analysis, it also does a great disservice to the client or research participant.

Misconception: TIC Does a Disservice to Those Who Have Experienced Traumatic Events or Suffer from Posttraumatic Stress Disorder

Some conversations around the proliferation of TIC have posited that taking an approach that acknowledges that anyone could have experienced traumatic events potentially does a disservice to those who are “genuinely” suffering with the effects of trauma. Critics of TIC posit that it discounts the experience and impact of more severe responses to adverse events, such as PTSD. To the extent that behavior analysts assume every emotional, dangerous, or otherwise challenging behavior is necessarily the effect of trauma, we share concerns about the utility of the construct of trauma in ABA. If everything is trauma, then nothing is trauma. Behavior analysts should be the first to acknowledge that behaviors can be evoked and maintained by a range of stimuli and that no stimuli produce a universal operant response across individuals. Rather than assuming trauma, practitioners and researchers might consider undertaking training for trauma screening or, alternatively, recruiting professionals who have trauma-screening expertise. It is important to note that screening for trauma requires an established referral system so that if a potential trauma history is detected, the client can be referred to the appropriate professional for further evaluation. In an ideal situation, trauma screening is directed at the individual who has experienced potentially traumatizing events, but those screenings will only reveal trauma if the individual chooses and has the capacity to reveal their history. For individuals who are very young or have limited language abilities, screenings must be conducted with a caregiver who also may not choose to reveal—or may not know—all relevant events. The potential for screening to fail to uncover all relevant events further emphasizes the need for TIC as a universal approach.

An important caveat is that even if screening reveals potentially traumatizing events, that does not provide definitive data that any behavioral issues are the result of trauma. The advantage of screening, apart from identifying the need for additional professional input, is that it provides additional information that may allow the behavior analyst to more fully consider the potential role of prior events on current behavior. In particular, it may allow the behavior analyst to design a more supportive environment that acknowledges why the current environment might affect an individual in the way it does. By considering the client’s potential interpretation of current events, we are (1) unlikely to exacerbate potential trauma responses and (2) able to build a solid and safe foundation on which to introduce challenges later down the line. This approach may be particularly important for individuals who have experienced trauma and have limited communication skills, given that engagement with trauma screening tools and most trauma-specific services requires relatively complex language skills.

Finally, it is important to remember that TIC frameworks are Tier 1 approaches aimed at ensuring all services are curated to provide a supportive experience underscored by safety, autonomy, and empowerment. A primary goal is to facilitate an individual’s engagement with whatever level of care they need (DeCandia et al., 2014; Harris & Fallot, 2001), which can range from less (e.g., general education with accommodations) to more intensive (e.g., trauma-specific therapy). Embracing TIC does not undermine any individual’s unique support needs; both TIC and trauma-specific services are aimed at ensuring that individuals get the support they need to live the lives they want. By adopting TIC practices, we are not dismissing the differential impacts that adverse experiences may have on individuals, nor are we suggesting that TIC should supplant trauma-specific therapies (Houck & Dracobly, 2023). Rather, we are proactively acknowledging the prevalence of trauma and behaving accordingly to support recovery.

Misconception: TIC is Simply Rebranding What Behavior Analysts Already Do

Rajaraman et al. (2022) concluded that the overreaching commitments of TIC are very much aligned with the design and implementation of behavior analytic assessment and intervention strategies and ethical frameworks. Acknowledging trauma and its potential impact, establishing a therapeutic relationship that is safe and trusting, promoting choice and participation in the therapeutic process, and prioritizing skill building over behavior reduction are practices that most behavior analysts already readily accept and engage in. The behavior analytic literature, past and current, is replete with examples of how behavior analysts regularly implement strategies that are consistent with the ethos of these commitments. Recent discussions of compassion (Rodriguez et al., 2023; Rohrer et al., 2021; Taylor et al., 2019), cultural responsiveness (Beaulieu & Jimenez-Gomez, 2022; Fong & Tanaka, 2013; Wright, 2019), and neurodiversity-affirming care (Allen et al., 2024; Mathur et al., 2024) also are relevant to demonstrating the myriad ways in which behavior analysts prioritize the individual needs of their clients and research participants. Indeed, focusing on contingencies at the individual level is a hallmark of behavior analytic work.

Despite the expanse of current good practices implicitly aligned with TIC, the degree to which those practices align with the full scope of TIC commitments is less clear. In this special issue, Pollack and colleagues suggest that despite the range of strategies that could be considered trauma-informed, such as empowering students through voice and choice, including family, culture, and community in the design of interventions, building healthy relationships between the client and others important to the client, and prioritizing interprofessional collaboration, use of these strategies was relatively uncommon when delivering school-based behavior analytic interventions for children with emotional and behavioral disorders. These findings are consistent Beaulieu et al. (2024), who initially found low levels of trauma-informed practices in the behavior plans of BCBAs working in public schools. In that study, increases in trauma-informed practices occurred following the use of a checklist and goal setting (i.e., improvements were observed when the behavior analysts were more intentional about how they designed behavior plans to align with the commitments of TIC). Taken together, these studies suggest that implementation of TIC practices must be intentional and may not otherwise occur on a consistent basis across behavior analysts or client constituencies.

To the extent that social validity exemplifies the commitments of choice and shared governance, we might expect that behavior analysts routinely engage in social validity assessment. However, Huntington et al. (2023) found that, between 2010 and 2020, fewer than 50% of the behavior analytic studies that met their inclusion criteria included social validation measures. Further, Ferguson et al. (2019) found that only 6% of articles published in the Journal of Applied Behavior Analysis between 1999 and 2017 assessed intervention acceptability by allowing individuals to choose. Leif et al. (2024) found similar results regarding the inclusion of social validity in studies published in the Journal of Applied Behavior Analysis between 2010 and 2020. In particular, the authors reported that 10.63% of studies assessed social validity by asking about intervention preferences, whereas 9.38% of studies allowed participants an opportunity to choose the intervention they would experience. Leif et al. further found that social validity assessments rarely were used to inform treatment decisions, with only 9.38% and 13.75% of studies assessing social validity before or during intervention, respectively. These data suggest a potential disconnect between social validity procedures and the concepts of choice, shared governance, and collaboration.

With regard to focusing on skill building as a TIC principle, the field of behavior analysis has produced robust literature on effective methodologies for teaching and maintaining a range of important skills (e.g., Slane & Lieberman-Betz, 2021). However, the degree to which skill-building interventions are prioritized over behavior reduction strategies is less clear. Identifying the proportion of studies that evaluate the effects skill building versus behavior reduction across behavior analytic journals might be helpful in determining the degree to which a habilitative approach is the norm in behavioral research. Altogether, these data suggest that although there are many good practices in behavior analysis that align with TIC, there is probably room for improving our engagement and intentionality of implementation. Aligning practices a posteriori helps us understand how the things we already do are consistent with TIC. However, being intentional a priori likely will increase the range of strategies we use to support individuals with and without trauma histories.

Misconception: Embracing TIC Means that We Are Acknowledging that ABA is Trauma-Inducing

Some professionals have interpreted the call to incorporate TIC into ABA as a tacit suggestion that proponents of TIC believe ABA procedures to be inherently trauma-inducing or trauma-exacerbating. They have further suggested that incorporating TIC into ABA practices is only necessary if those practices are traumatizing in nature and have argued there is no rigorous data that this is so. These arguments require nuanced unpacking.

First, we acknowledge that there are no data identifying a functional relation between ABA procedures and increased traumatic stress. As such, there exists no experimental evidence that ABA or any specific behavior analytic procedure is inherently traumatizing. Second, there are no published articles of which we are aware in which a behavior analyst who is a proponent of TIC suggests ABA assessment and intervention practices are traumatizing by their very nature. Advocating for TIC is a call to learn more about the pernicious nature and impacts of trauma, and to incorporate that knowledge into the decisions we make as helping professionals; it is not an indictment of the discipline. In fact, several other disciplines such as nursing, mental health services, education, and social work have advocated for and adopted TIC (Carello & Butler, 2015; Isobel & Edwards, 2017; Levenson, 2017; Sweeney et al., 2018).

Third, there are emerging descriptive and anecdotal accounts suggesting that some individuals with lived experience of ABA perceived their services to be violent, dehumanizing, and traumatizing (Anderson, 2023; Lynch, 2019; Kupferstein, 2018; Sandoval-Norton et al., 2019; Sparrow, 2016). Many of these anecdotal accounts were summarized in Mathur et al. (2024) in a commentary calling for a centering of autistic and neurodivergent perspectives in ABA practice and research. The accounts of individuals with lived experience of ABA may not constitute experimental evidence, nor do they represent all or even a majority who have received ABA services; however, we would be remiss as a discipline to not validate lived experiences and take seriously each individual account as important data.

For those less familiar with the effects of traumatic stress, it might be important to consider that posttraumatic stress symptoms might include responses like self-injurious behavior, aggressive behavior, and avoiding events that resemble prior traumatic experiences (Mayo Clinic, n.d.; National Center for PTSD, n.d.; U.S. Department of Veterans Affairs, n.d.). To the extent that the provision of certain ABA procedures coincides with increases (albeit temporary) in targeted self-injurious behavior or aggression (e.g., extinction-induced phenomena), one could potentially infer increased stress as a function of the presentation of events that are similar to previous, potentially traumatic events. However, as noted above, we may not know in any given moment whether a response is or is not related to a previous, potentially traumatic event. Whereas behavior analysts currently have tools like functional analysis, which help rule in and out various operant functions of behavior (e.g., escape from aversive events), we do not have similarly precise tools when it comes to delineating the impact of previous traumatic experiences on current situations (e.g., identifying the relation between an aversive event and maltreatment). As such, we cannot know if, for example, a repertoire of self-injurious behavior is a “trauma response,” if it is “just reinforced by escape,” or if it may be both. Within a preventative TIC framework, behavior analysts need not make inferential leaps. The role of TIC is to acknowledge what we do not and cannot know in the moment, and to be considerate as possible when developing strategies for intervening upon the self-injurious behavior.

Although behavior analysts may not need to know specific trauma-related environment-behavior relations to select and implement effective, behavior-analytic interventions, we should acknowledge that we often arrange for the presentation of aversive stimuli in order to teach alternative responses in the presence of evocative events (e.g., tolerating denials, waiting for preferred things, cooperating with nonpreferred tasks, inhibiting dangerous behavior). The intensity of that aversive stimulation, the manner in which teaching is conducted, and the extent to which the context ensures the individual’s safety and autonomy are all variables that could moderate their experienced or perceived distress. ABA procedures are by no means inherently traumatizing, but like other health or education procedures, how they are presented to service recipients can mimic prior trauma dynamics, thus giving credibility to a call to advocate for trauma-informed approaches to ABA.

Addressing the Research Gap

Although misconceptions about TIC are relatively easy to address, there remains a potentially bigger issue for a field grounded in scientific evidence. Research indicating that TIC produces better outcomes than non-TIC procedures is relatively nonexistent (e.g., Maynard et al., 2019). The lack of solid evidence, particularly given behavior analysts’ ethical obligations to engage in data-based practices, may cause behavior analytic organizations or training programs to minimize or forego incorporating TIC into their operating procedures. This may be why Katherine Wheeler and colleagues (in this issue) found that although behavior analysts reported training on trauma-related concepts is extremely important, the majority reported that they had little to no training in this area.

However, as noted above, although TIC as a unified approach currently lacks evidence, the commitments of TIC closely align with evidenced-based practice in behavior analysis and the Ethics Code for Behavior Analysts (BACB, 2020). These practices include collaborative service delivery, social validity, choice making, rapport building, assent, and informed consent among others. Further, behavior analysts are well-positioned to support experiences that have been correlated with resilience following exposure to adverse events, often termed “benevolent childhood experiences” (BCEs; Bethell et al., 2019; Narayan et al., 2018). BCEs are specific positive experiences in childhood, such as predictable routines at home, enjoying school, having at least one caring teacher, engaging in pleasurable leisure activities, having at least one good friend, having a supportive adult outside the family, and having a positive self-image. Research supports that BCEs have protective effects and improve resilience among those who have experienced potentially traumatic events (Bethell et al., 2019; Narayan et al., 2018). Many BCEs are compatible with practices in which behavior analysts can engage and program into their instruction, including maintaining and promoting positive child–caregiver relationships, developing supportive peer relationships, building rapport with learners, providing opportunities to learn leisure skills, developing predictable home routines, and enriching the school environment. In a study related to this, Kolu (2023) describes how behavior analysts can support buffers that, similar to BCEs, can mitigate the negative health impacts of adverse events. Buffers that have been linked to protective effects include having nurturing relationships, healthy nutrition, physical activity, healthy sleep, and mental health support, as well as actively reducing stress. By conceptualizing service delivery through the lens of TIC, behavior analysts can be more intentional and focus on aspects of service delivery that have been shown to have protective effects and are well within the scope of behavior analytic practice.

Finally, it might be important to note that other organizations grounded in evidence-based decision making (e.g., CDC, SAMHSA) have advocated for TIC. Behavior analysts might need to grapple with whether we need empirical support for every aspect of programming, or if some components that align with TIC should be a standard commodity for all service recipients. To the extent that we are ethically bound to engage in evidence-based practices, we believe that behavior analytic clinicians and researchers are particularly well-placed to document and analyze both the process and outcomes of TIC, with the aim of contributing to evidence-based decision making about how, when, and if these strategies should be incorporated into behavior analytic research and practice. Indeed, the aim of this special issue is to highlight behavior analytic research that considered the impact of trauma on the conceptualization, delivery, evaluation, and acceptability of behavior analytic assessment and treatment approaches. In the call for articles, we invited research employing a range of methodologies, but limited consideration to data-based manuscripts to ensure the special issue was introducing novel data to contemporary conversations surrounding TIC and ABA. However, the fact that the call for articles for this special issue produced a low yield of empirical submissions relative to that of other recent special issues suggests there is much more left to do. We hope this special issue stimulates conversation, curiosity, and further research in this important area so that evidence-based decisions and practices that are consistent with TIC are possible.

Advancing a TIC Research Agenda in Behavior Analysis

We hope this special issue provides a jumping off point for continued research on TIC in ABA. We acknowledge that the intervention-based research published here is primarily concerned with the process of integrating TIC rather than a comparative analysis of outcomes. Research demonstrating that engagement with TIC produces better outcomes for consumers is important but may be fraught with ethical landmines. However, there are exemplars of intervention comparisons on which we might base future research. For example, studies showing the relative benefits of choice (see Howell et al., 2019, for a summary) provide a good model for evaluating the benefits of engaging with specific aspects of TIC. Conducting similar evaluations that explore efficacy and satisfaction with co-designed interventions (i.e., shared governance) or that compare skill building to behavior reduction strategies might also be helpful in validating procedures that are aligned with specific commitments. In conducting these and other studies evaluating TIC, we encourage authors to consider incorporating a broader range of measures that capture both effects and side-effects of interventions. For example, researchers and clinicians might measure emotional responding, indices of happiness, attempts to leave a session, choices to engage, and duration of engagement as ancillary measures of the effects of a TIC approach. Further, considering that BCEs relate to safety, trust, and fostering resilience, future research could evaluate methods to promote increased BCEs across schools, homes, and communities.

Evaluating the effects of broader engagement in TIC, including impacts on organizational climate, consumer and staff satisfaction and retention, use of restrictive practices, and acquisition of skills is also imperative for the field to confidently embrace TIC. Regardless of the type of research one is conducting, we encourage researchers also to report participant histories of potentially traumatizing events or screening scores in much the same way researchers are calling for broadening participant descriptions regarding race, gender identity, socioeconomic status, and sexual orientation (Waits et al., 2023). Doing so may be helpful in evaluating the proportion of research participants with these histories, as well as documenting the processes, efficacy, and acceptability of behavior analytic interventions for this population.

Finally, considering the deleterious impacts of exposure to ACEs irrespective of intervention, research could evaluate methods to prevent exposure to ACEs by continuing to contribute to the wider literature evaluating procedures to promote healthy parenting strategies and strong caregiver–child relationships. According to Dr. Nadine Burke Harris, childhood trauma increases the risk of at least 5 out of 10 of the leading causes of death in the United States (CDC, 2021; The Burke Foundation, n.d.). In fact, children exposed to six or more ACEs have an average 20-year decrease in life expectancy due to all-cause mortality, a measure that is agnostic to specific causes of death (Brown et al., 2009). The average 20 years of life lost are, therefore, not due to or caused by symptoms of posttraumatic stress; on average, individuals who live through many potentially traumatic events in childhood tend to live shorter lives. Whether ABA has a role to play in preventing exposure to ACEs or improving such outcomes associated with traumatic stress remains to be seen; however, acknowledging the scale of the potential impact of trauma is perhaps the central tenet of TIC frameworks. We hope this special issue will inspire practitioners to consider TIC in practice and researchers to continue producing research in this important area.

Data Availability

This is a discussion article. There are no data.

Declarations

Competing Interests

The authors have no competing interests to declare that are relevant to the content of this article.