Behavior Analysts’ Training and Practice Regarding Trauma-Informed Care

Abstract

Discussion of trauma and trauma-informed practices continues to be elusive in behavior analytic research despite the consideration that 60% of men and 50% of women in the general public are estimated to experience at least one traumatic event in their lifetimes (National Center for PTSD, 2023). In addition, it is estimated that, beyond post-traumatic stress disorder, an estimated 61% of adults have experienced at least one adverse childhood experience (Centers for Disease Control & Prevention [CDC], 2019). It is clear from these statistics that neither trauma nor adverse experiences are uncommon. Further, these individual histories often affect future behavioral functioning, potentially resulting in the referral of the individual for behavioral services. The current study surveyed Board Certified Behavior Analysts to assess behavior analysts’ current practices and perceptions of trauma-related concepts and to offer insight into how behavior analysts perceive their competence in this area of diversity. Descriptive and Ordinary Least Squares regression analyses were conducted to identify the perceptions and relationships between training and understanding of trauma-informed practices. The majority of respondents reported that training on trauma-related concepts is extremely important, yet further reported having little-to-no training on trauma-related concepts across their graduate coursework, fieldwork supervision, or continuing education. Implications and future research are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-023-00836-7.

The current statistics on humanity’s experiences with trauma and adverse experiences indicates that the majority of individuals experience at least one traumatic event in their lifetime (i.e., 50%–-60%; National Center for PTSD, 2023; CDC, 2019). When considering the contemporary definition of trauma, it is imperative to look beyond the narrow clinical definition of Post-Traumatic Stress Disorder (PTSD) to understand trauma and the associated behavioral implications. Behavioral health professionals broadly define trauma as resulting “from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being” (Substance Abuse & Mental Health Services Administration [SAHMSA], 2012, p. 2). Notably, out of all individuals with a traumatic history, only a small percentage demonstrate symptoms that meet diagnostic criteria for PTSD. However, these subclinical symptoms experienced by those who have experienced trauma, but do not meet PTSD diagnostic criteria, have meaningful neurological and behavioral implications.

Trauma activates a neurobiological stress response. Although necessary for survival, chronic and frequent physiological stress responses can alter brain development, leading to dysregulation of neural circuitry (Carrion & Wong, 2012; Garner & Yogman, 2021). Neuroimaging studies have shown that trauma and toxic stress negatively affect the development of the prefrontal cortex and the hippocampus, areas of the brain that are responsible for new learning, memory formation, shifting attention, and forming stimuli–response associations (Carrion & Wong, 2012). Further, adverse experiences are psychosocial stressors that have been shown to correlate with poor behavioral health outcomes (Felitti et al., 1998; Petruccelli et al., 2019). Understanding adverse childhood experiences (ACEs) is a vital component of TIC because exposure to adversity can significantly affect development in children and increase the likelihood that a child will display stress reactions, or behaviors, adapted to cope with adversity (Petruccelli et al., 2019).

There is a paucity of academic research surrounding trauma-informed care (TIC) in applied behavior analysis (ABA; see Rajaraman et al., 2022). Discovering the perceptions of trauma and training in TIC amongst behavior analysts is critical. This is particularly important given the current statistics on humanity’s experiences with trauma, which indicates that the majority of individuals experience at least one traumatic event in their lifetime (i.e., 50%–-60%; National Center for PTSD, 2023; CDC, 2019). By illuminating the training and practices of board certified behavior analysts (BCBAs), a deeper understanding of current practices and potential needs for growth or support (e.g., incorporating trauma-informed content into certification programs or supervision processes, more detailed processes for broadening scope of competence, etc.) can be identified.

Individuals with autism spectrum disorder (ASD) are more susceptible to experiencing trauma and have been found to have significantly higher exposures to potentially traumatic experiences when compared to their typically developing counterparts (Haruvi-Lamdan et al., 2020; Rigles, 2017). Overall, there are many considerations and connections between trauma and trauma-related experiences that the ASD population may experience, which is beyond the scope of this current article to discuss (see Haruvi-Lamdan et al., 2020; Rigles, 2017). What is imperative is the recognition and understanding that individuals that are frequently served by behavior analysts are not immune to traumatic or adverse experiences that must be considered within their service programming. In fact, given the overall statistics of individuals experiencing adversity (e.g., traumatic or adverse experiences), it is highly likely that behavior analysts will provide services to individuals with trauma histories.

Despite the aforementioned considerations regarding trauma, the discussion of trauma and TIC continues to be sparse in behavior analytic research. Yet the presence of trauma and adverse events within the human population and the incorporation of diversity within the behavior analytic ethical guidelines (i.e., Code 1.07) all serve as foundational support to bridge TIC with ABA services. Recently, Rajaraman et al. (2022) described four commitments for behavior analysts to incorporate into their service delivery to better support clients with trauma histories. The four commitments include: "(a) acknowledge trauma and its potential impact, (b) ensure safety and trust, (c) promote choice and shared governance, and (d) emphasize skill building” (Rajaraman et al.,2022; p. 44).

Rajaraman et al. (2022) behaviorally define safety and trust as a reliable freedom from harm. In terms of ethics, behavior analysts are obligated to “maximize benefits and do no harm” (Behavior Analyst Certification Board [BACB], 2020; p. 4). Benefiting others emphasizes the protection of clients. This should include the protection of clients from intervention procedures that could exacerbate adverse experiences or even retraumatize. Further, behavior analysts are required to consider scope of competence (see 1.05, p. 9; BACB, 2020). This code protects clients by ensuring the practitioner is either already competent or is working to ethically expand competency. Without this process, there is a possibility of increased risk and harm, which in turn implicates codes 2.01 and 2.15 (i.e., providing effective treatment and minimizing risk of behavior-change interventions; BACB, 2020), all of which are housed under the umbrella of reliable freedom from harm. With respect to behavioral programming, rapport building and conducting social validity assessments are ways behavior analysts can incorporate features of safety and trust (see Shillingsburg et al., 2019; Wolf, 1978).

The second commitment of TIC, promoting choice and shared governance, directly aligns with evidence-based practice in behavior analysis and the Ethics Code. Choice has been firmly embedded in the extent behavior analytic literature from the emphasizing the right to choose personal liberties (see Bannerman et al., 1990) to well-established preference assessment procedures (Hagopian et al., 2004). Choice has been embedded into antecedent-based intervention approaches as a preventative approach (Kern et al., 2002; Staubitz et al., 2022). Yet, Ferguson et al.’s (2019) review found that only 6% of articles published in the Journal of Applied Behavior Analysis between 1999 and 2016 incorporated choice in the intervention procedures. Further, when considering the provision of ethical services, core principle two (i.e., Treat Others With Compassion, Dignity, and Respect) indicates that behavior analysts acknowledge personal choice within service delivery (BACB, 2020). This, in large part, can be combined with Code 2.11 (obtaining informed consent) to ensure the receipt of informed consent and assent. Behavior analysts should further consider assent throughout the provision of services, including throughout a session, rather than simply at the onset of services. This would allow clients with a trauma history to have a level of agency to indicate when they are experiencing stressors and are not in a state of perceived safety that would affect skill acquisition, thereby affording continued choice and safety within intervention services.

Behavior analytic practice places a strong emphasis on the final commitment of TIC, skill building. ABA strives to make meaningful improvements in socially significant behaviors (Heward et al., 2022). However, the impact of ABA on supporting those who have been exposed to adverse experiences, including traumatic events, is still lacking in the scientific literature. Yet, the updated ethics code implores behavior analysts to consider cultural diversity within programming via Code 1.07, which should not proscribe a trauma history. Exposure to adverse experiences can create diversity by derailing the development of an individual, which may further compound into disability (i.e., PTSD, developmental delays, mental health disorders; Garner & Yogman, 2021). Furthermore, Hartas (2019) has linked perceived ACEs to cultural and ethnic differences, indicating that different cultural groups hold distinct beliefs and behave in unique ways that are best served with responsive programming. These individual histories combined with exposure to adversity may further affect operant conditioning contingencies of the learner, which should be addressed in appropriate and responsive programming, further implicating Code 2.01 (providing effective treatment).

Code 2.01 denotes a responsibility to (1) provide evidence-based behavioral services that maximize outcomes while protecting clients from harm; and (2) only provide nonbehavioral services with the appropriate scope of competence (BACB, 2020). This is entangled within the context of TIC and ABA due to the limited extent literature outlining the efficacy of ABA services with a population that has a trauma history but also clearly calls for a level of competence before considering nonbehavioral services. Individualized services within behavior analysis serve to protect clients from harm given the ethical obligation to adjust ineffective treatment and provide appropriate referral should treatment remain ineffective. Further, individualized services allow behavior analysts to incorporate a trauma-informed approach given certain evidence-based ABA practices align with TIC (Rajaraman et al., 2022).

Furthermore, the core ethical principle of treating others with compassion, dignity, and respect specifically states that individuals should be treated with equity regardless of personal factors or characteristics, which should not preclude a trauma history. Further, this core principle also requires that behavior analysts respect and promote self-determination with an emphasis on vulnerable populations (BACB, 2020). This indicates that services for individuals with a trauma history should include their ability to have agency in the provision of services that would support their safe and effective treatment.

Rajaraman et al. (2022) provided foundational trauma-related service considerations for behavior analysts; however, the amount of training behavior analysts have received on TIC and how to implement TIC in practice is currently unknown. The current study sought to identify and outline current approaches that behavior analysts engage in to expand their scope of competence into the area of trauma, as well as their perceived levels of familiarity and comfortability implementing TIC. While the field continues to provide supports across the human experience, understanding scope of competence as well as the perceived need for specific training in TIC is critical to continue to support our practitioners as well as our clients. The current study sought to also elucidate contemporary practices in the training and supervision of behavior analysts. By providing this information surrounding current behavior analytic practices, the extent literature would be expanded to offer insight into how behavior analysts perceive their competence in this area of diversity and how we can improve the process to better serve the learner who seek services. This study sought to answer the following questions:

1. How and in what amount do behavior analysts receive training for working with people who have a trauma history during their coursework, fieldwork or practicum, and/or continuing education?

2. What are the perceptions of behavior analysts regarding training on this topic? For example, how important do they believe the training is; how comfortable and competent in working with individuals who have adverse experiences do they feel?

3. Does exposure to trauma-informed practices predict perceived comfortability and competency in providing TIC?

Method

Participants

Participants were recruited via the mass email service operated by the Behavior Analyst Certification Board (BACB). Invitation emails were sent to more than 56,000 BCBA certificants and of those, 245 individuals agreed to participate. Eligibility criteria included holding a current BCBA or BCBA-D (Board Certified Behavior Analyst- Doctoral) standing. Of those 245 participants, 232 completed the study (completion rate = 94.7%) providing survey responses for data analysis. No monetary compensation was provided for study participation. Table 1 presents the demographic characteristics of the participants (N = 232).

Table 1.

Participant demographics

Variable	n	%
Age
< 30	20	10.4
30-39	81	41.9
40-49	51	26.5
50-59	28	14.6
60-69	12	6.2
70-79	1	0.5
80+	0	0
Gender
Male	28	12.1
Female	198	85.3
NonbinaryNon-binary/Third gender	2	0.9
Prefer not to say	3	1.3
Prefer to self-describe	1	0.4
Race
White	195	84.4
Black or African American	5	2.2
Asian	8	3.5
Native Hawaiian or Pacific Islander	1	0.4
American Indian or Alaskan Native	5	2.2
Two or more races	9	3.9
Prefer not to say	4	1.7
Prefer to self-describe	4	1.7
Ethnicity
Hispanic, Latinx, or Spanish origin	27	11.7
Non-Hispanic, Latinx, or Spanish origin	194	84.0
Prefer not to say	10	4.3
Degree Level
Field of Master’s Degree
Applied behavior analysis	82	35.3
Behavior analysis	13	5.6
Psychology	40	17.2
Education	68	29.3
Other	29	12.5
Field of Doctoral Degree
Applied behavior analysis	5	2.2
Behavior analysis	4	1.7
Psychology	12	5.2
Education	12	5.2
Other	13	5.6
No doctoral degree	186	80.2
Holds additional credential(s)*	98	42.2
Certified teacher	52	22.0
Licensed therapist	15	6.4
School psychologist	5	2.1
Clinical psychologist	3	1.3
Other	35	14.8

^* Question allowed for multiple select

Measures

This study modified the survey questions from Beaulieu et al. (2019) to measure bbehavior analysts’ experience and comfortability with trauma-related concepts. In this study, the survey consisted of 78 questions asking about (a) demographics; (b) importance of training on TIC; (c) comfort level for working with individuals with exposure to adverse experience; and (d) training experience in TIC including precertificationpre-certification supervision, post-certification continuing education, and current practices as a supervisor of other behavior analysts and/or a course instructor (see Table 3 for a summary of the questions). Definitions of trauma and adverse experiences were not provided in the survey. Survey questions about importance, comfort, and training were presented in a Likert-type format (see Table 4 for a summary of the questions). Questions about demographics were presented as multiple choice. The survey was administered online via Qualtrics^TM and took approximately 10 minminutes to complete. The survey is available as a supplemental material accompanying this article.

Table 3.

Pre- and post-certification exposure/experience in TIC

Variable	n	%
Exposure to working with individuals with adverse experiences in behavior analytic coursework
Master’s
None at all	120	64.2
A little	55	29.4
A moderate amount	9	4.8
A lot	3	1.6
Doctoral
None at all	20	55.6
A little	11	30.5
A moderate amount	4	11.1
A lot	1	2.8
Exposure to working with individuals with adverse experiences in non-behavior analytic coursework
Master’s
None at all	99	52.9
A little	57	30.5
A moderate amount	23	12.3
A lot	8	4.3
Doctoral
None at all	14	38.9
A little	14	38.9
A moderate amount	8	22.2
A lot	0	0
During pre-certification fieldwork, did your supervisor
Give resources for TIC
Yes	33	18
No	150	82
Provide education on TIC
Yes	27	14.8
No	156	85.2
Provide practice opportunities to incorporate TIC
Yes	30	16.4
No	153	83.6
Provide consultation using TIC on a case involving adverse experiences
Yes	38	20.8
No	145	79.2
Amount of hands-on experience dedicated to working with individuals with exposure to adverse experiences
None at all	83	45.4
A little	58	31.7
A moderate amount	31	16.9
A lot	11	6.0
Post-certification
Sought to expand scope of competence to include TIC
Yes	187	91.7
No	17	8.3
Expanded via . . .…*
Appropriate study	109	58.2
Training	127	67.9
Supervised experience	25	13.3
Formal consultation	43	23.0
Informal consultation	66	35.3
Co-treatment with competent professional	83	44.4
Number of CE hours on TIC (total)
0-5	87	52.7
6-10	40	17
11-15	12	7.2
16-20	15	9.1
21-25	2	1.2
26-30	3	1.8
31-35	1	.6
36-40	1	.6
41-45	0	0
46-49	0	0
50+	4	2.4

^*Question allowed for multiple select

Table 4.

Familiarity, importance, comfortability, and scope of competence in trauma-related areas

Variable	n	%
Familiarity with term/definition/concept adverse experiences
Not familiar at all	8	3.5
Slightly familiar	25	11.0
Moderately familiar	82	35.9
Very familiar	113	49.6
Familiarity with term/definition/concept of trauma
Not familiar at all	0	0
Slightly familiar	17	7.5
Moderately familiar	84	36.8
Very familiar	127	55.7
Familiarity with term/definition/concept of trauma-informed care
Not familiar at all	3	1.3
Slightly familiar	36	15.7
Moderately familiar	89	39.0
Very familiar	100	43.9
Importance of training on adverse experiences
Not important at all	2	.9
Somewhat important	9	4.1
Moderately important	23	10.6
Very important	183	84.3
Importance of training on trauma-informed care
Not important at all	3	1.4
Somewhat important	9	4.2
Moderately important	25	11.6
Very important	178	82.8
Comfortability working with individuals who have been exposed to adverse experiences
Not at all comfortable	6	5.3
Somewhat comfortable	30	26.8
Moderately comfortable	44	39.3
Very comfortable	32	28.6
Comfortability providing trauma-informed care
Not at all comfortable	24	11.2
Somewhat comfortable	63	29.3
Moderately comfortable	83	38.6
Very comfortable	45	20.9
Scope of competence in working with individuals who have been exposed to adverse experiences
Not at all competent	18	8.3
Somewhat competent	68	31.3
Moderately competent	99	45.6
Very competent	32	14.7
Scope of competence in providing trauma-informed care
Not at all competent	27	12.6
Somewhat competent	75	34.9
Moderately competent	84	39.1
Very competent	29	13.4

Data Analysis

Descriptive statistics were used to investigate the nature and amount of training BCBAs receive in TIC and their perceptions on the importance of training and how comfortable and competent they feel in TIC delivery. Chi-square test of independence was performed to examine the relationship between BCBAs’ degree type and amount of coursework related to TIC. This test statistic was used to determine whether the difference between the observed and expected values between degree type and amount of coursework was significant. Additionally, we conducted OLS regression to examine the relationship between BCBAs’ pre- and post-certification experiences (independent variables) and their perceived comfort and competence in TIC delivery (dependent variables). OLS is often conducted to describe the relationship between one or more independent variables and a dependent variable. All analyses were conducted using SPSS (Statistical Package for the Social Sciences) 28.0.

Results

Participant Demographics

The sample demographics are provided in Table 1. The majority of participants were Wwhite (84.4%), non-Hispanic, Latinx, or Spanish origin (84.0%) females (85.7%) between the ages of 20 and 39 (52.3%). All participants (100%) held a master's degree, in applied behavior analysis (35.3%), education (29.3%) or other similar disciplines; beyond this, 21.5% earned a doctoral degree. In addition to BCBA certification, about half of the participants were also holding other credentials such as certified teacher (22%), licensed therapist (6.4%), school psychologist (2.1%), and/or clinical psychologist (1.3%).

Table 2 shows the employment characteristics of the sample. Participants were primarily practitioners of direct services (36.2%) or supervisors (35.3%) who worked in either clinics/centers (30.2%), clients’ homes (22.4%), or public schools (20.3%). The majority of participants worked with individuals diagnosed with autism (67.4%) or in special education (12.4%). About one third of participants reported a high caseload of working with individuals exposed to adverse experiences (i.e., > 70% of clients; 34.8%) while about one sixth of respondents reported not having access to/inquiring about adverse experiences (15.2%).

Table 2.

Participant employment characteristics

Variable	n	%
Primary role as BCBA
Practitioner of direct services	84	36.2
Supervisor	82	35.3
Administrator	28	12.1
Lecturer/Instructor	7	3.0
Professor/Researcher	10	4.3
Other	21	9.1
Primary employment setting
Public school	47	20.3
Private school	7	3.0
Client’s home	52	22.4
Clinic or center	70	30.2
College or university	15	6.5
Residential	17	7.3
Hospital	2	0.9
Community	10	4.3
Other	12	5.2
Population of primary employment
Autism spectrum disorder	147	67.4
Intellectual disability	21	9.6
Special education	27	12.4
Mental health	6	2.8
General education	5	2.3
Employees	2	0.9
Other	10	4.6
Proportion of clients with exposure to adverse experiences, including trauma
Less than 10%	13	11.6
10%-19%	4	3.5
20%-29%	6	5.4
30%-39%	13	11.6
40%-49%	3	2.7
50%-59%	12	10.7
60%-69%	5	4.5
70%-79%	17	15.2
80%-89%	9	8.0
90% or more	13	11.6
I do not have access to or inquire about adverse experiences, including trauma for the clients I serve.	17	15.2

Research Question 1

Coursework

Table 3 shows the participants’ training experience during their pre-certification coursework and pre- and post-certification fieldwork. About two thirds of participants reported they did not complete any coursework related to TIC (63.8%) during their ABA master’s program, with 93.9% receiving “‘a little”’ or “‘none at all”’ collectively. Likewise, during non-ABA master’s program, most participants did not complete any coursework related to TIC (52.1%), with 84.5% reporting receiving “‘a little”’ or “‘none at all.”.’ Doctoral level ABA coursework also did not entail education on TIC for most participants enrolled in these programs (62.8%). Overall, 88.4% of doctoral level participants received “‘a little”’ or “‘none at all”’ in terms of coursework related to TIC. Further, 44.2% received no coursework related to TIC in non-ABA doctoral courses, and, collectively, 81.4% of participants reported receiving “‘a little”’ to “‘none at all”’ during non-ABA doctoral courses. The results of chi-square test indicated that the participants having a doctoral degree were significantly more likely to have coursework experience in TIC than those having a master’s degree (χ² (1) = 18.86, p < .001).

Pre-certification Fieldwork Experience

Participants were asked questions regarding their experience with TIC during their pre-certification fieldwork. During their supervised fieldwork, most participants (82.5%) were not offered from their supervisor(s) any resources (e.g., articles, web links, etc.), education (85.9%; e.g., as would be provided during supervision sessions), practice (85%), or case consultation (81.1%) of implementing TIC. Also, 46.6% reported no hands-on training (collectively 77.2% little-to-no training) in TIC during their pre-certificationprecertification fieldwork.

Post-certification Training and Experience

Participants were further asked to report their exposure to and training in TIC after receiving board certification in behavior analysis. Questions also included their competency in this area, including how they expanded their competency under the Ethics Code for Behavior Analysts (BACB, 2020). Most participants reported seeking an expansion of competency in TIC (91.7%). Of those, 58.2% reported expanding their competency through appropriate study, 67.9% training, 13.3% supervised experience, 23.0% formal consultation and 35.3% informal consultation, and 44.4% co-treatment with a certified professional. When asked about continuing education (i.e., “‘training”’) in TIC, about half (52.7%) reported receiving between 0 and 5 hr of continuing education in TIC, with 14.5% receiving no continuing education (i.e., 0 hr).

Research Question 2

Table 4 shows the participants’ familiarity with the definitions, terms, and concepts related to trauma, perceptions of TIC, comfortability with TIC, and scope of competence in trauma-related areas. About half of the participants reported that they were very familiar with the definition/term/concept of adverse experiences (49.6%), trauma (55.7%), and TIC (43.9%). Many participants believed that training for working with individuals who have adverse experiences and TIC is very important (84.3% and 82.8%, respectively). In addition, participants primarily reported that they are moderately comfortable with working with individuals with adverse experiences (39.3%) followed by very comfortable (28.6%) and reported feeling moderately comfortable providing TIC (38.6%) followed by somewhat comfortable (29.3%), indicating a consensus in some level of comfort providing TIC to the participants’ respective caseloads. Participants primarily reported their scope of competence in working with individuals with exposure to adverse experiences as being moderate (45.6%) followed by somewhat competent (31.3%), and primarily reported being moderately competent in TIC (39.1%) followed by somewhat competent (34.9%).

The results of ordinary least squares (OLS) regression are summarized in Tables 5 and 6. There was a significant relationship between the familiarity and the scope of competence (β = 0.34, p < .001) indicating that participants who were more familiar with the concept of TIC felt more competent in delivering TIC. Likewise, participants who were more comfortable working with individuals with adverse experiences felt more competent in TIC delivery (β = 0.51, p < .001).

Table 5.

Regression results for predicting scope of competence in TIC

Variable	b	β	p
Additional credential	–0.19	–0.11	.14
Continuing education hours	0.03	0.34	< .001
Familiarity with concept of TIC	0.35	0.34	< .001
Comfortability working with individuals with exposure to adverse experiences	0.34	0.51	< .001
Supervision exposure to TIC	–0.001	–0.27	< .001
Degree level	–0.09	–0.04	.62
Behavior analytic coursework	–0.11	–0.06	.41
NonbehaviorNon-behavior- analytic coursework	–0.03	–0.02	.84

Table 6.

Regression results for predicting comfortability in implementing TIC

Variable	b	β	p
Additional credential	–.20	–.11	.11
Continuing education hours	0.05	0.34	< .001
Familiarity with the concept of TIC	.63	.52	<.001
Comfortability working with individuals with exposure to adverse experiences	.76	.73	<.001
Supervision exposure to TIC	–0.001	–0.30	< .001
Degree level	.10	.03	.72
Behavior analytic coursework	–.13	–.05	.53
NonbehaviorNon-behavior- analytic coursework	.12	.05	.54

Research Question 3

As shown in Table 5, neither participants’ degree level nor exposure to TIC coursework (regardless of behavior analytic or not) was significantly related to their scope of competence in delivering TIC. Also, holding additional credential had no impact on the competence (β = –0.11, p = .14). However, the number of continuing education hours in TIC significantly predicted the competence (β = 0.34, p < .001)—i.e., as the number of continuing education hours increases, so does the participant’s perceived level of competence. Likewise, familiarity with the concept of TIC as well as comfortability in working with individuals with exposure to adverse experiences were significant predictors of perceived scope of competence (β = 0.34, p < .001, β = 0.51, p < .001, respectively). It is interesting that, there was a negative association between the pre-certification TI opportunities and perceived competence in TIC (β = –0.27, p < 0.001).

Table 6 presents the results of predicting the comfortability in delivering TIC. Similar patterns were noted between the predictive variables and scope of competence and participants’ perceived comfortability in delivering TIC. The number of continuing education hours participants took regarding TIC was positively related to their level of comfortability (β = 0.34, p < .001). There was also a significant relationship between familiarity with the concept of TIC and perceived comfort delivering TIC (β = .52, p < 0.001) as well as comfort working with individuals exposed to adverse experiences and perceived comfort (β = .73, p < 0.001). These relationships indicate that the more familiar with the overall concept of TIC and the higher the perceived level of comfort working with those who have experienced adversity, the higher the perceived comfort in delivering TIC. However, there was a significant negative association between the pre-certification TI opportunities and the comfortability (β = -.30, p < 0.01), indicating that participants who had less exposure to resources, education, practice, and/or consultation during their pre-certification supervised fieldwork felt more comfortable in delivering TIC. There was no significant relationship between holding an additional credential, degree level, or type of coursework and perceived comfort in TIC (see Table 6).

Discussion

This study sought to illuminate the perceptions and practices of behavior analysts in the realm of trauma and TIC. Results indicated that most participants reported that training in trauma and TIC is very important. The majority reported they are moderately to very comfortable working with individuals exposed to adverse experiences, yet a majority reported receiving little to no coursework related to working with individuals who have had exposure to adverse experiences. Further, a majority reported receiving little to no resources, hands-on experience, practice, education, or consultation on TIC from their fieldwork supervisor(s). There was a predictive relationship between exposure to pre-certification resources, education, consultation, and hands-on experience that was negatively associated with feelings of competence and comfortability, indicating that the more comfortable participants felt delivering TIC the less likely they were to report exposure to resources, education, practice, and/or consultation in their pre-certification supervised fieldwork. The reason behind this result is unclear and future research may consider delving deeper to uncover further implications behind this statistic. Further, the results of this study indicated that limited hours appear to be accrued via continuing education. In fact, over half of the participants reported only receiving between 0 and 5 hr of continuing education in TIC. The number of continuing education hours did significantly predict feelings of increased competency and comfortability. Ultimately, results indicate little pre- or post-certificationpostcertification training yet moderate levels of perceived competence.

Most participants reported seeking expansion of competency in TIC, indicating that comfortability and competence may come after certification. Appropriate study and training were the two most selected categories of means to expand competency. It should be noted that the ethics code on the expansion of scope of competence does not provide operational definitions for practitioners which serves as a limitation for the current study. For example, “appropriate study” is a term used within the Ethicsal Code but is lacking in further expansion to describe what precisely is entailed within appropriate study. Training, the primarily selected category, is also not defined in the Ethics Code, but may hold the weight of continuing education. It is plausible that the experience accrued by direct work with individuals who have had exposure to adverse experiences might be a variable that was not accounted for, given that 50% of participants reported that 50% or more of their clients have had exposure to adverse experiences. Conversely, respondents indicated limited exposure to hands-on experiences in pre-certification as well as limited supervision or co-treatment post-certification. This warrants consideration due to ethical implications, given that under the expansion of competency (Code 1.05; BACB, 2020), direct, independent hands-on experience is not a consideration for appropriate expansion (Beaulieu et al., 2019).

Further, as evidenced by the data, many of the participants reported awareness and familiarity of the concepts of adverse experiences, trauma, and TIC, yet the pre-certification and post-certification data is demonstrating a lack of coursework, hands-on experience, and even a robust level of continuing education in these trauma-related areas. There is a significant positive relationship between familiarity with the concept of TIC and the perceived scope of competence in delivery of TIC as well as a significant positive relationship between comfortability with TIC delivery and perceived scope of competence. However, when looking at the limited responses in the positive for both pre- and post-certification experiences, including holding an additional credential, where this comfortability stems from is still unclear. Future research may benefit from a qualitative approach to identify themes in comfortability and perceived scope of competence and how these perceptions manifest in various practitioners.

The results from this survey provide contributions to the extent literature by outlining the importance of training in TIC for behavior analysts. By demonstrating the value of content, practice, and training in this realm, research and professional development may be expanded to provide further support to behavior analysts. The respondents have demonstrated their perceived value of TIC in the field and yet have reported little to no training, which provides a bridge for future research to support.

The findings of this study have a variety of implications for both research and practice. The evaluation of behavior analytic principles with individuals who have been exposed to adverse experiences should be considered in the behavior analytic research. This should include the disclosure of participant demographics in a more comprehensive manner to better understand the application and generalization of findings (Jones et al., 2020). This is important because there may be differential responding of individuals with different demographic backgrounds that may occur within the context of the same intervention (Jones et al., 2020). Examining the impact of trauma on psychological, social, and academic functioning is vital for meaningful treatment. Further, how these practices are implemented within a population experiencing a trauma history and how efficacious they may be would expand the extent literature and provide a stronger foundation for the intersection of TIC and ABA. By cautiously incorporating the historical presence of trauma or adverse experiences in research demographics, there could be a robust expansion of literature assessing the effectiveness of behavior analytic strategies that the field tends to lean on as being aligned with trauma-informed practices (e.g., DRA, elimination of extinction procedures, choice, etc.). Although beyond the scope of the current study, this approach would also open future research to determine the current intervention practices of behavior analysts and thereby provide data on how TIC looks in practice. Moreover, from an applied perspective, the ability to review the existing literature that discloses trauma histories in the demographic section allows practitioners a better lens to view the target intervention (see Staubitz et al., 2022).

At the applied level, practitioners can continue to seek out training on TIC through continuing education opportunities or appropriate study through the extent literature. The competent delivery of trauma-informed practices is a process that should be carefully considered. The foundational step to delivering TIC is the acknowledgment of trauma (see Rajaraman et al., 2022). Behavior analysts can seek appropriate expansion in the acknowledgment and screening of trauma through appropriate training or consultation in screening for trauma from qualified professionals (see Code 1.05; BACB, 2022). However, the work is not done after merely acknowledging trauma. Ensuring safety, promoting choice, and prioritizing skill-building need to be addressed with careful consideration to align with the four core commitments. While the ABA literature base seeks expansion under this intersection of TIC and ABA, practitioners can look to the literature surrounding pairing procedures, skill acquisition, social validity, and antecedent-based intervention strategies that currently support, in part, the four commitments of TIC.

Further, given the reported percentages of practitioners serving individuals with trauma histories (see Table 2), considering the impact of traumatic events on social, emotional, and behavioral functioning may better equip practitioners to provide meaningful, supportive care. One method of evaluating the impact may be through compassionate assessment of challenges (see Michna et al., 2023), with a key caveat being the cautious implementation to avoid re-traumatization.

Limitations and Future Research

This survey did not delve deeper into expansion of competency, which limits the current study’s ability to determine whether individuals who said they “sought” expansion of competency simply considered it or actively pursued expansion. Further, the limited questions on competency affects the current study’s ability to identify specifically why participants reported they feel moderately to very comfortable in working with individuals with adverse experiences and moderately competent in providing TIC with little to no training.

A limitation of the current study was the lack of questions asking respondents if they received pre-certification training that may not have been labeled "TIC,” but that potentially trained the respondents to consider adverse events during individualized programming. For example, the survey did not inquire about training practitioners have received on behavior analytic practices that align with TIC (e.g., skill acquisition interventions and choice). Further, while the authors intentionally chose not to define the terms within the study, this serves as a limitation due to lack of operationalized terminology which may impactaffect perceptions of familiarity (e.g., respondents may be familiar with a trauma-related term, but it may be different among respondents).

There are numerous behavior analytic approaches to emphasizing skill building such as skill acquisition procedures, direct instruction, natural environment training, behavioral skills training, differential reinforcement of alternative behaviors (Granpeesheh et al., 2009; Leaf et al., 2015; Petscher et al., 2009; Shillingsburg et al., 2015). However, within the field of behavior analysis, there is limited understanding on how often practitioners are emphasizing the implementation of these skill-oriented approaches over other, less skill-oriented, approaches (e.g., differential reinforcement of other behavior, differential reinforcement of lower rates, noncontingent reinforcement, punishment-based procedures, etc.). This study did not delve into the frequency of practices related to the four core commitments (e.g., DRA, choice, social validity, etc.) implemented in lieu of other, non-skill basednonskill-based, practices. This information should be considered for future research to reflect on which practices are being prioritized.

An additional limitation to the current study is the possibility of selection bias, in that those who responded may have a divested interest in trauma and TIC. However, if that is the case, it is still glaring, given the statistics on perceived scope of competence. This indicates needs within the behavior analytic community for stronger supports for practitioners who work with those with a trauma history. The current study clearly indicates that respondents believe in the value of TIC and training on TIC. This concludes in the simple fact that the field has already set their sights on incorporating or emphasizing aligned practices. The majority of the respondents agreed that determining the efficacy of ABA within trauma-informed practices is important to our field’s future. Knowing perceptually where we stand as a group of practitioners can support the generation and implementation of socially significant interventions for a range of individuals that will support their futures.

Overall, our results support that some behavior analysts recognize the importance of TIC; however, there is still work to be done in the field to expand the extent literature and ensure appropriate consideration of trauma histories are incorporated into behavior analytic programming. Expanding the literature on best practices of TIC in ABA may inform training, practices, and improve the quality care for individuals with trauma histories.

Supplementary Information

Below is the link to the electronic supplementary material.

Funding

This work was supported in whole or in part by the EC&ML Foundation. The opinions and conclusions expressed in this document are those of the author(s) and do not necessarily represent the opinions or policy of the EC&ML Foundation.

Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Competing interests

The authors declare that they have no conflict of interest.

Protection of Human Subjects

Research for this study was approved by an institutional review board. Before beginning the survey, individuals were provided with an informed consent form embedded in the survey that they were required to complete to access the survey. Those who agreed to participate were free to stop the survey at any point with no negative consequences. No identifiable data was collected.