Is Eating Too Many Doughnuts and Taking a Nap Culturally Responsive and Trauma-Informed?
Having been a BCBA since 2000, I am interested in the history of our field, because, frankly, I’ve lived a good portion of it. One of my all-time favorite journal article titles is “Balancing the Right to Habilitation with the Right to Personal Liberties: The Rights of People with Developmental Disabilities to Eat Too Many Doughnuts and Take a Nap” by Bannerman, Sheldon, Sherman and Harchik (1990). I’ve often thought about this article as I’ve followed our field’s growing emphasis on providing culturally responsive treatment and trauma-informed care. This emphasis can be seen, in part, as a response to the criticisms of our field, such as we are controlling and manipulative (Sandoval-Norton & Shkedy, 2019). However, I believe that our field has been sensitive to the personal liberties of those with autism spectrum disorder and intellectual disabilities for the past 35 years and that the seeds of our current focus on culturally responsive treatment and trauma-informed care can be found in this article. What follows is an attempt to align the key points of the article with relevant aspects of culturally responsive treatment and trauma-informed care.
Bannerman, et al. (1990) began by discussing the right to habilitation. They noted that individuals with developmental disabilities had historically received poor services and the right to habilitation was won as a result of many class action suits. They next reviewed the concept of personal liberty for this population, highlighting that personal liberty should include having a range of options for valued, life decisions and that choice-making should be free from coercion. While they raise doubts about the “free” aspect of choice making (given that in ABA choices as determined by of our behavioral history), they note that, “Not only do people strive for freedom in a broad sense, they also enjoy making simple choices, such as whether to engage in unproductive, though harmless, activities, like watching sitcoms on television, eating too many doughnuts, taking the afternoon off from work, or taking a nap before dinner.” This was followed by a discussion of how personal liberties have been compromised and they suggest steps that should be taken to protect those rights. Their main focus is on the value and importance of client input and choice-making. Bannerman, et al. note four ways that clients’ liberties had been compromised: 1. They have little input into their treatment goals or the procedures that are employed in habilitation, 2. Staff do not consider client preference when selecting treatment goals, 3. Choice-making is rarely taught, and 4. Few opportunities for choice are provided. They argued that people should be allowed to express their preferences and have the opportunity to make choices whenever possible. Not only is providing input and opportunities for choice-making a protected right, they noted that research has shown that learners prefer situations that allow choice versus those that don’t allow choice. Offering choices also has a positive impact on participation and task performance.
Gomez-Jimenez and Beaulieu (2022) in their paper: “Cultural Responsiveness in Applied Behavior Analysis: Research and Practice”, call for the field to improve its provision of culturally responsive practices. They note that involving clients and stakeholders is required in our ethics code (BACB, 2020), and they outline several culturally responsive practices that mirror those recommendations from Bannerman, et al. (1990). These include collaborating with caregiver on treatment goals, offering choices of treatment, seeking and incorporating feedback to improve performance, and conducting social validity assessments.
Rajaraman, et al. (2022) in their article “Toward Trauma-Informed Applications of Behavior Analysis” identify four guiding principles of trauma informed care, two of which echo Bannerman, et al. (1990): promoting choice and shared governance (i.e. allowing all participants to have a voice in treatment decisions) and emphasizing skill building. Promoting choice and shared governance is viewed as helping consumers regain control over their lives, which aligns with Bannerman, et al.’s call for respecting personal liberties. While shared governance was not a common term in 1990, it can be defined as the opportunity to provide input into treatment decisions and collaboration with treatment providers, again, seen in Bannerman, et al.
I welcome our current focus on culturally responsive and trauma-informed practice. These practices are required by our ethical code and we should continue to research and refine our practices so we can be more collaborative, more trustworthy for stakeholders, and, as a result, more effective. I also believe that our acceptance by the general public requires this as well. However, I want those who are newer to the field to realize that behavior analysts have been supporting the rights of those with disabilities for decades. Our field’s earliest applied studies successfully addressed problem behaviors (Allyon & Michael, 1959) and taught skills to individuals that others providers could not help (Azrin & Foxx, 1971). Behavior analysis has a long history of providing effective treatment to individuals and stakeholders who ask for help. I anticipate these efforts will become more client-centered and even more effective as we continue to evolve.
References
Ayllon, T., & Michael, J. (1959). The psychiatric nurse as a behavioral engineer. Journal of the experimental analysis of behavior, 2(4), 323–334. https://doi.org/10.1901/jeab.1959.2-323
Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of applied behavior analysis, 4(2), 89–99.
Jimenez-Gomez C, Beaulieu L. Cultural responsiveness in applied behavior analysis: Research and practice. Journal of Applied Behavior Analysis. 2022 Jun;55(3):650-673. doi: 10.1002/jaba.920.
Rajaraman, A., Austin, J. L., Gover, H. C., Cammilleri, A. P., Donnelly, D. R., & Hanley, G. P. (2022). Toward trauma-informed applications of behavior analysis. Journal of Applied Behavior Analysis, 55(1), 40–61. https://doi.org/10.1002/jaba.881
Sandoval-Norton, A. H., & Shkedy, G. (2019). How much compliance is too much compliance: Is long-term ABA therapy abuse? Cogent Psychology, 6(1), 1641258.