Demographic questions ask about the characteristics of human populations, including gender & sex, age, race & ethnicity, geography, and income. In research, demographic questions are oftentimes an important and integral part of the study and data. However, there is a risk to both the participant and the data in asking demographic questions. Asking about demographics can feel triggering to the participant making them feel unsafe, which is why questions need to be framed in a culturally sensitive way and asked at the right time.
Being asked about their trauma histories has the potential to create negative reactions among clients (SAMHSA, 2014a). Treatment providers are, therefore, sometimes apprehensive to administer assessments that ask clients about trauma histories (SAMHSA, 2014b). What’s different about the UBI is that it focuses on current behavior—what clients are doing these days, rather than what has happened to them in the past. In this way, it can provoke less anxiety than many of the tools used in treatment, for both client and treatment provider.
The Unsafe Behaviors Inventory (UBI) asks clients to self-report how often they are currently engaging in various unsafe behaviors (e.g., fighting, overeating, using substances, etc). There are 66 behaviors listed in total, including an additional field for clients to describe other behaviors they consider unsafe. Clients use a scale (see Figure 1) to indicate the frequency of each behavior, ranging from “Never” (scored as 0) to “Several times a day” (scored as 12). When the client completes the UBI online, a cumulative “score” is automatically generated, summing all of the client’s responses. The lowest possible score on the tool is 0, and the total possible is 792. The point is not to get to zero, necessarily, but to mark progress as a reduction in each client’s cumulative score.
The Unsafe Behaviors Inventory (UBI) began back in 2011, when clients in a group treatment benefited from a list of unsafe behaviors. I started “collecting” them: every time I heard of a new one, I wrote it down. As the list grew longer, clients said, ” I didn’t know that was unsafe!” or sometimes “I did not realize how safe I actually am!”. With the help of the 2012 Amherst College summer Intern Sharleen Phillips and several subsequent summer interns, it became clear that the tool was very helpful and easy to use. However, to do a study to validate it as an effective measure required something called an Institutional Review Board (IRB) approval. The IRB process took more than five years, and we could not use much of the data that we had collected before it began. We had to start over.
“Children develop within an environment of relationships that begins in the family but also involves other adults who play important roles in their lives. This can include extended family members, providers of early care and education, nurses, social workers, coaches, and neighbors,” states the Center on the Developing Child at Harvard University in From Best Practices to Breakthrough Impacts: A Science-Based Approach to Building a More Promising Future for Young Children and Families (2016). The seemingly benign statement is fraught with potentially negative results.
A recent publication on creating trauma informed programs for sexual assault programs (available for download on the Resources page), quoted the National Center for Trauma-Informed Care, “Trauma-informed care is an approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives.”
This is a key definition to our understanding of trauma informed care as it relates to service provision. For too long and with dire consequences, mental health, substance abuse, domestic violence, child abuse intervention, hospitals, and schools—among others—simply saw challenging and unproductive behavior as a reflection of the person’s character or lack there of. By becoming trauma informed, we can understand the context of the behavior in order to see some of the historical and interactive but less visible aspects of the behavior.
Founded in 2009, the California Center of Excellence for Trauma Informed Care is an organization dedicated to helping publicly funded agencies understand the impact of trauma on their clients, both individually and as a group, and to then use that understanding to design programs (interventions, policies, training) to work more effectively with their clients. Using the Fallot and Harris (2001) framework from “Using Trauma Theory to Design Service Systems” as the foundation from which to then build and strengthen the entire publicly funded social service system. Fallot identifies key values from which a trauma-informed program can develop: safety, trustworthiness, choice, collaboration, and empowerment.