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.
After administering the UBI, we ask providers to complete a brief questionnaire pertaining to how the process went, for the client and for themselves. We do this to make sure we have an accurate sense of how the UBI assessment process is going, for clients and for treatment providers, including whether or not clients feel safe during the UBI process.
According to data from this follow-up tool, we find that most clients have a neutral reaction, although some clinicians say that the client actually responded positively. (There was only one case [2%] where it was reported that the client had a negative reaction). The most common positive client reaction cited in the clinician follow-up data was that the client “stated something positive.” It was also fairly common for clinicians to note that clients “learned more about unsafe behavior,” “became interested in reducing their unsafe behaviors,” and “felt the clinician wanted to help them.”
Treatment providers themselves were most likely to have a neutral response to administering the UBI, although a notable minority (22%) had a positive reaction. They were slightly more likely than clients to have a negative reaction, which is consistent with research showing that clinicians tend to over-estimate client discomfort with structured interviews such as the UBI (Bruchmüller, et al., 2011). This same research showed that clinicians tend not to use structured interview tools (into which category the UBI falls), despite the recognition that they are a best practice in client treatment. Additional research shows that clinicians can be very critical of assessment tools, which can discourage them from using them at all (Connors, et. al., 2015). Given this context, the proportion of treatment providers reporting a positive experience with administering the UBI tool is important and encouraging. It is also promising to see that clients tend to feel neutral-to-positive in response to taking the UBI.