Unsafe Behaviors Inventory (UBI) Pilot Study
A key principle of trauma-informed care is recognizing the importance of improved safety. But how can we measure improved safety as a treatment outcome? Would you like to join an effort to develop a tool to measure unsafe behaviors and help to measure how effective a variety of treatments are in reducing unsafe behaviors?
The California Center of Excellence for Trauma Informed Care is beginning a pilot study to validate the Unsafe Behaviors Inventory to help programs focus more specifically on unsafe behavior reduction as a means of providing trauma-informed care.
Using the Unsafe Behaviors Inventory
What Is the UBI?
The Unsafe Behaviors Inventory (UBI) is a tool designed by the California Center of Excellence for Trauma-Informed Care (CCETIC) to measure reductions in unsafe behaviors. Administered at the beginning of a client’s participation in trauma-informed supports (“T1”), and again in 8–12 weeks (“T2”), the UBI helps treatment providers and clients themselves to recognize reductions in risky or destructive behaviors. There is an adult version of the UBI (UBI-A) and a youth version (UBI-Y).
Who should use the UBI?
The UBI should be used by treatment providers delivering trauma-informed, safety-focused, and skill-building services and supports, especially if they believe that those services and supports are likely to result in changes in client behavior over time. Treatment programs need not be clinical, but they should be trauma-informed. We recommend that the pre and post assessments be administered approximately 8–12 weeks apart, with the pre-assessment administered just as treatment is beginning.
Is the UBI Validated?
The UBI has not yet been validated. CCETIC is in the process of validating the tool. The only way you can currently use the UBI is to participate in the validation study.
I Want to Use the UBI: What Should I Do?
The UBI-Y and UBI-A are available for use with no cost or licensing fee. However, since the UBI is currently in the process of being validated, treatment providers must agree to participate in the validation study in order to use the tool with clients.
If you are a treatment provider and you want to use the tool, please go to the online provider agreement and read through the terms. All treatment providers participating in the UBI Validation Study will be asked to obtain informed consent with every client. The consent forms can be found below (note: for minors, informed consent is a two-step process). Once consent is obtained, treatment providers should administer a baseline assessment (T1). After administering the baseline UBI assessment, providers must complete a brief Provider Input questionnaire. This should only take 5–10 minutes, and gives treatment providers an opportunity to reflect and report on client and provider reactions to the UBI. After 8–12 weeks of treatment (Tx), providers should re-administer the UBI (T2). Providers may provide additional feedback if they so choose.
How Do I Administer the UBI?
Once treatment providers have completed the agreement to participate in the UBI Validation Study, they will have access to the links for the UBI-A and UBI-Y, which are exclusively available online. It can be self-administered by clients or administered by a treatment provider. Clients’ confidentiality is protected through an identification code system that enables us to track client changes without the use of client names. Depending on each client’s reading fluency and learning differences, the time required to take the UBI may range from 10 minutes to 30 minutes.
Will We Know the Results of Our Clients’ UBIs?
When a client or treatment provider completes a UBI, the results from the assessment will appear on the screen. Providers may print or save these results as a PDF for comparison with previous or future UBI results. These results will show responses to each question as well as a numerical score which represents the level of risk/unsafe behavior (the higher the number, the more unsafe the behavior). When interpreting the numbers, it is important to note any questions that were skipped, as the number of questions skipped should be subtracted from the total possible score (the tool will not automatically do this).
If treatment providers would like a full report of their program’s aggregate results, they may enter into an agreement with CCETIC who can produce reports at the program or agency level, or more nuanced reports that consider pre-post differences disaggregated by race, gender, or other variables.
We Are Ready to Use the UBI: What Do We Do Next?
- Register to be a treatment provider participating in the UBI Validation Study here: https://www.surveymonkey.com/r/UBI-Provider_Agreement
- Incorporate consent procedures and forms into your practice. Access our forms here: Adult Consent Form, Youth Consent Form, Parent/Guardian Consent Form for Youth
- Start using the UBI as a part of intake procedures, and follow up with every client after 8–12 weeks of treatment. You will obtain links for the UBI-Y (for youth) and the UBI-A (for adults) once you have completed the UBI provider agreement.
- Remember to provide input after administering the UBI with each client here: https://www.surveymonkey.com/r/UBI-Follow-up
For any questions or comments, email traumainformedcalifornia@gmail.com
The History of the UBI
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…
Measuring Improved Safety
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…
Provider Follow-Up Data: Reflections on the UBI
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.
Demographics of the UBI
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.