Trauma-Informed Behavioral Health Services (with Alexia Stack, BCBA from A Block Above Behavioral Consulting)

Trauma Informed Behavioral Health Services Featured Image

Erika Ng is joined by Alexia Stack, a Behavior Analyst specializing in taking a trauma-informed approach to her work. She discusses how she uses trauma-informed behavior-analytic services to help young people who’ve experienced traumatic events. Many of her clients have no formal diagnosis, but their behavior has unfortunately become a barrier to community inclusion. Alexia uses a trauma-informed approach to support these clients with complex behavioral health needs.

Interview Highlights:

  • Alexia Stack is a behavior analyst who specializes in taking a trauma-informed approach to her behavior analytic work. She has written a research paper on current evidence-based resources to treat trauma in individuals with autism. [1:00]
  • Alexia currently has her own behavior analytic practice called A Block Above, serving a very wide variety of clients. She completed a graduate-level research paper on treating individuals with autism who have experienced trauma. [1:15]
  • Alexia has been in the field of behavior science for over 20 years. She has a wide breadth of knowledge and an innovative spirit. She has sought out the best possible treatment by becoming skilled in the area of trauma-informed behavior treatment. [1:36]
  • Alexia had been working with families on her caseload who had both known and unknown trauma occurring in the home and the community. The kids that she was working with were pretty unique in how they would respond to different behavioral interventions and practices. [3:41]
  • Alexia was interested in going back to school and completing a PhD at the time so she started to look for research specifically in the field of behavior analysis as it relates to trauma and autism.  [5:51]
  • Many of her clients are on the autism spectrum but oftentimes they’ll have multiple diagnoses [6:51]
  • Sometimes Alexia works with kids with Pervasive Demand Avoidance (PDA). Families may come to her with genetic disorders and oftentimes there will be an additional diagnosis of autism [7:29] 
  • Some clients have a diagnosis of Oppositional Defiant Disorder (ODD) with autism as well.  [7:51]
  • Alexia often has parents call her seeking help whose children don’t have any kind of diagnosis and they’re looking for behavioral support. Alexia is happy to work with families who have children in foster care [8:05]
  • Alexia had a lot of people coming to her with repeated stories of their kids at three or four years old being kicked out of many daycares or preschools. They’re getting removed from those kinds of childcare environments because their behaviors are intense and they don’t have a formal diagnosis [9:23]

“Sometimes it’ll be a matter of years before they are sent in the right direction, or before parents are strongly encouraged to go get a formal diagnosis.” — Alexia Stack

  • Alexia advertises specifically that she works within a trauma-informed framework. She has developed a sub-specialty in that area. [11:27]
  • When that history of trauma is openly spoken about, there’s a level of acceptance there on the part of the parents. Alexia will ask them to provide the diagnostic reports that they may have. Any school reports, or any kinds of counselor or psychological reports that they might be able to provide can be part of developing a really general assessment plan. [13:18]
  • Alexia has to develop a treatment plan that takes the things that she’s learned from the reports while establishing and developing a relationship and putting them into a program [15:50]
  • The assessment process might look a little different than typical behavior analytic services. Alexia might spend more time with that particular child establishing rapport and a good relationship. Only then she can actually start to go into a language, life skills or  behavior assessment and so on. It does require a lot of flexibility. [16:30]
  • Everything that Alexia does as part of her treatment model is built around providing trauma-informed care. Whether a family comes to her with a known or unknown history of trauma, or no known trauma whatsoever, she is ready to include a trauma-informed lens [17:37]
  • One component of the assessment process is making sure the clinician has a safe and trusting working relationship with the child, client, or the adolescent client. Alexia teaches her learners that when they withdraw assent, she will respect that. [18:28]
  • Another significant part of trauma-informed work is understanding the nervous system. It’s critical to understand how the nervous system is affected when a client has experienced trauma [20:40]
  • They work on things like co-regulation with kids who don’t have self-regulation skills established yet. Co-regulation is when an adult who is calm, steady and regulated themselves helps the child that they’re working with complete the cycle of regulation. Eventually they move towards self-regulation through a lot of different mindfulness practices to build those abilities and skills. [21:05]
  • Another component is working to establish strong alliances with other professionals that are responsible for the client’s care. Alexia doesn’t do any of this work entirely on her own without the collaborative support of psychologists, social workers, counselors and school staff who are all part of the child’s team. [22:55]
  • Alexia is going back to graduate school so that she can do more work directly with parents using Acceptance and Commitment Therapy (ACT). [24:08]
  • Alexia does a lot of work in present moment awareness and mindfulness practices within the realm of behavior analysis. She does this work with kids, youth and adults. [25:16]
  • Alexia also seeks to understand what kinds of environmental triggers bring up flashbacks for her clients. They address this not in order to treat the trauma, but in order to prevent flashbacks from occurring in sessions by unknowingly triggering the individual [26:37]

Having provincially funded mental health support for kids and their families is the only way that this is going to be accessible for everybody.” — Alexia Stack

  • Alexia firmly believes that mental health should be treated like physical health. [28:18]
  • As it stands, those who can access mental health services– whether they’re provided by a behavior analyst, counselor or psychologist– are families that tend to have the financial resources in order to be able to provide their kids with that specialized support and treatment. [28:55

“For a lot of people there’s a lot of darkness around trauma, but really there’s a lot of light and there’s a lot of hope when you work through it.” — Alexia Stack

Guest Bio:

Alexia is a Board Certified Behavior Analyst (BCBA) with over 20 years of experience working with toddlers, children, teens, and adults with Autism Spectrum Disorder (ASD). She received her Bachelor of Arts in Psychology from Simon Fraser University (SFU) in 2001, and her Master of Education from the University of British Columbia (UBC) in 2006. Her graduate coursework concentrated on the study of Autism and developmental disabilities.

Alexia is Clinical Director of A Block Above Behavioral Consulting. Alexia maintains a moderately sized caseload, allowing her to have direct contact with her own clients. Additionally, she provides supervision and training to a team of behavior consultants, whose aims are to become Board Certified Behavior Analysts. Alexia has a varied knowledge base of behavior analytic techniques including: Precision Teaching (PT), teaching to fluency, Direct Instruction (DI), Verbal Behavior (VB), Natural Environment Teaching (NET), Incidental Teaching, and Discrete Trial Teaching (DTT). Alexia is a PEERS certified instructor, and runs sessions with colleagues in her community.

Alexia is a sessional instructor at the University of British Columbia, and Capilano University, where she teaches courses in the department of Applied Behavior Analysis (ABA) and Special Education. She teaches courses in principles of ABA and the education of individuals on the Autism Spectrum. She has developed a research interest in the study of the treatment of trauma in children with Autism, and plans to expand her education and training in this area of study in the near future. Although Alexia works with a wide range of clients between the ages of 18 months and 40 years, she has developed a specialization in teaching pragmatic language and social skills, academics, emotion regulation to children and youth, and has expanded her skills to include programming for adults with ASD.

Alexia maintains ongoing membership with the Association for Behavior Analysis International (ABAI), the Standard Celeration Society, and the British Columbia Association for Behavior Analysis (BC-ABA).

Alexia regularly presents her applied work at the Annual Convention for Applied Behavior Analysis, and has developed and presented workshops for parents, professionals, and schools in British Columbia. Alexia continues her education by attending conferences and workshops annually, locally and internationally.

Photo Of Alexia Stack

“I really wish that more of us would learn to present ourselves in such a way that we were seen as people who can provide care, treatment, and support because many of us are super capable of it.”

— Alexia Stack

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We’re trying out transcribing our podcasts using a software program. Please forgive any typos as the bot isn’t correct 100% of the time.

Read the Transcript:

Erika Ng

Thank you for listening in today. I’m Erika Ng, the founder of the Behavioral Health Collective. We know that trauma has very little to do with what an observer might perceive to be traumatic, but has everything to do with how an individual proceeds and experience. As parents, our children are often in the hands of other caregivers, whether this be at school, camp, extracurriculars, breastfed, or babysitting. Even when we’re with our children, experiences can happen and I don’t mean I perceive to be traumatic for that child that ends up affecting them in an adverse way in the long run. Perhaps you’re a foster parent of a child with a long trauma history that involved repeated experiences of witnessing violence and vector abuse. 

If you parent young children or children who have limited language skills, knowing how a child was affected by an experience maybe extremely challenging fast. I think any parent would find this conversation interesting and it will at least hopefully create a better sense of empathy for families that have experienced traumatic events. 

I first heard today’s guest at the BCBA conference in early March 2020. Alexia Stack is a behavior analyst who specializes in taking a trauma informed approach to her behavior analytic work. She presented her research into current evidence-based resources to treat trauma in individuals with autism. This is a really powerful session, I recall. She currently has her own behavior analytic practice called A Block Above serving a very wide variety of clients, and did her master’s thesis on treating individuals with autism who had experienced trauma and her paper she planted that there’s a lack of research in this area.

 But presents a modified treatment design based on trauma, based CBT, which is a well-established evidence-based trauma treatment for a typically developing individual. Alexia has been in the field of behavior science now for 20 years. She has a wide breadth of knowledge and an innovative spirit to seek out the best possible treatment and what else for our clients, by becoming skilled in this area of trauma informed behavior treatment. 

I’m really excited to speak with her today and try this conversation with you about her work in trauma informed behavior analytic work. She will also share more about her use of acceptance and commitment training also known as act, which we’ll refer to both as act and acceptance and commitment training in the podcast. And also sharing her approach to treating trauma and working with families. So here we go, I will introduce you to Alexia Stack.

Welcome to Behavioral Health Collective podcast, a community of behavior analysts who are passionate about sharing evidence-based practices from the perspective of behavior science. We connect families and educators to information that promotes robust behavioral health in the home, community, and classroom.

We are behavioral health practitioners who empower parents and caregivers by sharing behavioral resources that are current and evidence-based. 

At the Behavioral Health Collective, we set families and educators up for success by promoting meaningful and lasting behavioral health and skill development in the children or young people they work with.

Related Read: How To Hire A Board Certified Behavior Analyst (BCBA)

Erika Ng

Hi there, Alexia How are you doing today? 

Alexia Stack

I’m doing great. How are you doing today? 

Erika Ng

Great. Thank you so much for being here today, and I’m just really excited to be speaking with you about this area of trauma and just your background. So thank you for coming to share your expertise with me. 

Alexia Stack

Thanks for inviting me. I feel super honored to be here, so it’s fantastic.  

Erika Ng

So I guess let’s get right into the questions. So I guess, just to introduce yourself a little bit to the listeners, how did you first get really interested in trauma-informed behavior science in particular? So you are a behavior analyst, but how did you get into this niche in particular?

Alexia Stack

Yeah. So I think that there are several pieces that kind of, I think came together in a timely manner or sort of coincidentally at the same time for me. First piece was I was working with different families on my caseload, who had both known and unknown trauma occurring in the home and in the community at the time.

So the kids that I was working with were pretty unique in how they would respond to different like behavioral interventions and practices. And in particular, I noticed when you know, they were asked to do certain things in their sessions, they would run away or pull away or escape, whatever words you want to use about it in ways that were really different than most of my other kids.

So they would You know, sometimes they would run and curl up into a tight little ball, which was pretty different than some of the other learners that I had been working with over the years. And sometimes they would run and hide under furniture and they were completely non-responsive to you know, typical redirections and typical ways in which we would get kids to come back to work and get them responding to us and so on.

And so they were, they looked like they were more freezing almost, if you think about like a fight-flight-freeze response. And sometimes even they would verbalize what was happening for them this was pretty evident, that they were experiencing flashbacks in those moments. So which you know, I don’t know exactly what I was doing when I was asking a child to, for example, like do some math questions and all of a sudden I’m hearing about, you know, some experience that had happened in at school that was not related to math necessarily. But probably the fact that I was asking about math, then triggered some sort of a trauma response.

So, you know, those behaviors that I would sometimes think, Oh, well, they’re just trying to get out of what I’m asking them to do didn’t look the same basically, so they presented really differently and I had several kids like that all at the same time that I was working with. And you know, the other thing at the time as I was at that same time along all of that, I was learning a lot about my family’s history in the second world war. And kind of its effects on us as a family, and what gets passed down and what gets carried down in terms of family trauma histories and so on.

So, you know, that just kind of opened up the door and developed some curiosity around people’s lived experiences and life stories. And then that just kind of naturally extended to the families that I was working with at the time and then also I was interested in going back to school and completing a PhD at the time.

And so I started to just read or I started to look for readings in our field specifically of behavior analysis as it relates to trauma and autism. And I found that there was just really nothing out there at all at the time. And even, you know, several years later, there’s very little literature in this area as applies to kids with developmental disabilities.

So kind of all those things together put me forward on this path of wanting to learn more and write and present and all of that so, yeah. 

Erika Ng

Okay. That’s that’s interesting. Yeah, it was a perfect confluence of lots of different things. So do you do currently serve some clients with autism? Do you also have clients that do not have autism or have you worked with some of these kids in the past?

 And then also, I guess part of that would be, do you take foster families or have any contracts with, you know, our ministry of child and family services? 

Alexia Stack

Yeah. So, I mean, a lot of my clients, like you said, are on the autism spectrum but oftentimes they’ll have multiple diagnoses or like comorbid diagnosis as well.

So, their autism may not be like the prominent reason even necessarily, for why they may be coming to seek services. Like I often will have a family who might have a comorbid diagnosis of like ADHD, for example, with autism. And oftentimes even like, kids will get an autism diagnosis because autism ADHD can look really similar to one another in certain learners, right?

So, you know, that will sometimes happen or I work sometimes with kids with pervasive demand avoidance. As part of their diagnosis, sometimes families come to me with genetic disorders and oftentimes there will be that like I said, that diagnosis of autism built in there. And I think that comes down to funding issues, and you know, a lot of these disorders present themselves in fairly similar ways. And sometimes kids also have opposition or are labeled with, I don’t like to say have, or, you know, they’re given the diagnosis of oppositional defiant disorder along with their ASD as well. So, that’s kind of the caseload predominantly at this time.

But I’ve often had parents call me seeking help who don’t have any kind of diagnosis and they’re looking for behavioral supports for their children. Yeah. And, you know, in terms of the ministry and contracts and so on, I happily would work with families who have children in foster care. But I don’t have specific contracts with the ministry.

I somehow manage to keep really busy without that in place, so, yeah, I can’t imagine, like, it would be lovely. It would be great, but that’s not the way that my practice is set up. 

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Erika Ng

Fair enough, capacity. 

Alexia Stack

Yeah, exactly. 

Erika Ng

Yeah. So you’re saying that some of the diagnosis, like although a client would come to you with autism, you’re saying that some of the challenges that are being presented are maybe coming from a different diagnosis that they have is what you’re saying. Okay. Yeah. 

Alexia Stack

Yeah. And even like what we know of traumas is that trauma can look a lot like ADHD and trauma comes up a lot like autism as well. And so sometimes, you know, those things are overlaid and you have comorbid symptoms happening from the, from who knows which actually really. 

Erika Ng

Yeah, interesting. 

Alexia Stack

So. 

Erika Ng

So, I guess, could you give us a bit of an idea of what sorts of families or situations families find them in before they come to you?

Like when they’re coming to seek services, like what kind of challenges are they observing at home and the community potentially?

Alexia Stack

I mean, a really big one, like a way stepping away from the autism staff. What I’ve had a lot of people coming to me with are repeated stories of, you know, my daughter is, or my son is three years old, four years old, and we’ve been kicked out of this many daycares or preschools.

And so they’re getting removed from those kinds of childcare environments because their behaviors are intense and they don’t have a formal diagnosis or anything like that. And so people don’t know how to provide the right kinds of supports and so on, so that’s occurred pretty frequently.

And you know, sometimes it’ll be a matter of years before they are kind of sent in the right direction, or before parents are really strongly encouraged in order to go get a formal diagnosis. They’re often at the end of their ropes, and they’re really stressed out and kind of almost like in a state of desperation for some kind of support, in some kind of help. And a big variable that kind of steps in the way really quickly becomes a funding issue actually.

So. You know it’s, they might be directed in the right way, by somebody that they’ve come across in the community that says, Hey, you should probably really go find somebody who specializes in behavior and behavior supports and so on. But then they come looking for that support and they very quickly actually find out that they don’t have the funding, they can’t afford it and then I think they don’t really know what to do. 

Erika Ng

Yeah. I mean, you’ve touched on really what the goal of this whole endeavor of the Behavior Collective is, you know, has just creating better awareness and hopefully down the road, better funding for services. ‘Cause you know, it sounds like a lot of families are coming to you and then not, and not having the funding there available, which is such a hard conversation. 

I can imagine to have with the family to say like, you know, these are the costs of services, but it not being available there. So just a quick question as well about how you advertise your services. Do you advertise that you do work with a trauma-informed lens specifically, or the, you take clients who have a trauma, a background of trauma is that part of your service?

Alexia Stack

Yeah, so I do actually advertise specifically that we work within a trauma-informed framework, and trauma-informed practice, on my bio it’s specified that I have developed a sub-specialty in that area as well. I don’t advertise per se that you know, these are the kinds of clients that we take on are the clients that we specialize in.

But our websites needing some updates and some changes to it anyways, and so I’ll be adding some specific like bullets or points around, you know, for example, providing acceptance and commitment training as part of my practice. And specifying, you know, families who have or for children or even youth and adults who have, you know, histories of trauma.

 For example, but the adult is an individual client on the autism spectrum, for example so that there would be multiple reasons for why they may come seek supports and services. Yeah, I’ve just I’ve noticed more and more that people are like, kind of narrowing down how they advertise or promote their behavior analytics services. And I’m kind of late to that party a little bit right now. So yeah. 

Erika Ng

But obviously, yeah. Obviously very specialized, so that’s that’s great that is we’ll be out there I suppose, on your in your site as well. Now, so when you are taking in a client who does have a trauma background, could you walk us through what your intake process might look like that would be different from a typical intake process for behavior services? Or have you kind of merged it, so you’re covering your bases, you know, whether someone has a trauma background or not? 

Alexia Stack

Yeah. That’s a really good question. So in some ways it’s merged and in some ways it’s different and it really varies from client to client.

Like there’s a lot of flexibility, but You know, if the hiss if there’s like a known history of trauma and the parents openly talk about it, and they will readily and happily share information with you. Then the process is always pretty much the same at this point. Its just you know, I’ll get to it in just a second, but how much information I gathered will vary a little bit from client to client. But when that history of trauma is openly spoken about, there’s a level of acceptance there on the parents that happens.

I’ll ask them to provide, you know, the diagnostic reports that they may have. Any school reports, any kinds of counselors or psychological reports and so on that they might be able to provide as part of just kind of developing a really general assessment plan introductory a really big piece is having a really high level of flexibility.

And the reason being is that many of the kids and teens that come to me who have that history there, the biggest issue, and the biggest hurdle to overcome initially, is feeling safe and developing a trusting, working relationship. If you imagine, well this family is maybe ultimately hiring me to teach some academic skills, or some life skills, or some social skills and provide them with maybe a family positive behavior support plan.

But if I can’t get past relationship building in the first three to four appointments, that would typically be part of my you know, assessment process. Then I come out of that well, I have that relationship and that rapport now, but I don’t really necessarily yet know what that client can do. So it can be really tricky.

I’ve had for example like situations where I’ve literally spent, like four appointments in a couple of weeks that are a couple to a few hours long. And all we’ve really done in that time and I’m not meaning by all in such ways to minimize it. It’s actually a really big deal, so if you have a client who has a really complex history of childhood trauma, then those four appointments being able to have establish any kind of safety and security with you know, another adult being present and stuff like that is a huge, like, thing to establish and create and overcome in a lot of ways. And so I may not know for example, what that teenager can and can’t do after those four appointments which is really different than when you kind of program within just like here’s your little three-year-old who has a diagnosis of autism. Or here’s you know same thing, but now we’re like eight years old for example, and we have a diagnosis of autism.

That’s come a little bit later it can be very different, you know? So here I have, these are all my treatment goals my, here’s my treatment plan, and here is like Oh, well now you’ll willingly sit with me for an hour, but you know, again, because of funding limitations and all those different pieces that are part of our part of this puzzle, you know, well we get along really well.

And now maybe I can start to ask you some things, but what you know, or what you can do and things that you can’t do and assess those different skill areas. So. So I’ve had lots of cases where it’s like okay well I’ve just used is that eight hours of time and resources but this is what I’ve done in that time.

And from there, I have to develop a treatment plan that’s kind of essentially taking the things that I learned while establishing and developing a relationship and putting them into a program. And then from that point forward, a lot of changes will happen. And you know, maybe the learner’s program is like not at the level that they’re at, but then we make lots of changes on an ongoing basis afterwards.

Erika Ng

That makes sense. 

Alexia Stack

Yeah. Yeah. So that’s kind of what it ends up, what it can look like. You know, and then other kids like maybe their trauma happened early in life and but they have one secure, really stable parental figure who’s really established like a good solid ground in a safe ground at home for them.

And so the assessment process might look a little different, like I might spend I might have to spend them less time with that particular child establishing rapport and establishing a good relationship. And then I can actually start to go into like a language assessment, or going to a life skills assessment, or going to a behavior assessment and so on. So it it does require a lot of flexibility. Really. 

Erika Ng

Yeah. No kidding, so it’s very yeah. Tailored to the needs of a client then. 

Alexia Stack

Yeah. Absolutely. Absolutely and then if like somebody comes to assessment and I assume it’s going to go, you know, it’s like very linear fashion. And then suddenly something comes up and it’s not, you know, and I suspect something else has happened in that learner’s life.

Then again, I adjust and I change what I’m doing based on the assessment process, but that almost tends to happen less. Like many families are very forthright and very open about histories. 

Erika Ng

Yeah. Yeah. That’s great. So very flexible intake process itself. So then from there, can you describe a little bit about your treatment model maybe that for a family or a client that has experienced trauma and then what are some of those considerations you might be taking into account?

Alexia Stack

Yeah. So, You know, I think that in general, I kind of touched on it is that everything that we do as part of our treatment model is my whole practice is built around providing trauma-informed care at this point. So whether a family comes to us with a known history of trauma, or an unknown history of trauma potentially, or no trauma whatsoever, a lot of the different components of how I set up programs and treatment. 

And for us you know, it’s not treatment in the sense of like a psychotherapy or anything like that, like behavior analytic treatments, right? But it’s all there are lots of different components that will be the same across the board, and across the different families that I’m working with in general.

And then each, you know, if the family does have a known history of trauma, then there might be some things that are idiosyncratic to that particular family and team and needs and so on. But yeah there are many components, so like I said like I was touching on with the assessment piece. The first piece is making sure that we have safe and trusting working relationships with the child, client, or the adolescent client.

And that’s across the board kind of for everybody that we have strong therapeutic alliances with the parents as well. Another big piece to how I develop and set up programs is to teach my learners that I’m working with that when they withdraw a scent. So when they say in some way, whatever it is no, I don’t want to be doing this right now.

That that gets honored and reinforced, always so that the client’s voice, the learners’ voice comes first above and beyond whatever might be on my own agenda in terms of like teaching and instruction and stuff like that. And Yeah it would be ultimately great, if all of my kids say, Hey, you know this I really don’t want to do this thing today.

But oftentimes that might look like you know pulling away from the table starting to engage in some sort of like more aggressive behaviors and so on. And those are those withdrawals of assent are honored, and then we started to focus on like really calming down and emotion regulation strategies, and so on.

And then we come back to work and come back to those tasks and goals, but we don’t work through, we don’t push through any kinds of you know, learning circumstances that might be aversive to the learner. That’s a really huge piece. 

Erika Ng

Yeah. Okay, that makes sense. 

Alexia Stack

Yeah. And then like as oftentimes as behavior analysts they might ask, well, doesn’t that just reinforce, escape, maintain behaviors?

And and we definitely take data on everything that we do, so that we can make really good database decisions around those things and sure. If that’s happening, then we adjust what we’re doing, but more often than not it actually leads to just again it leads to an environment that teaches the child that my voice has meaning and you know, I can say no, I can have an opportunity to calm down and regulate, and then I can get back to this thing that maybe I wasn’t enjoying doing in a moment. 

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Erika Ng

That makes sense, and I guess having that component of teaching that like the teaching opportunity of the self-regulation and emotional awareness. 

You know, that’s so powerful that, you know, I’m sure at some point they do start learning that as a skill and able to identify.

Alexia Stack

Yeah, they absolutely do. Yeah. And yeah, that’s actually its own like component as well. So it’s withdrawals of a Sandton, and what do we do with that? When we say that we don’t want to do the work.

So, you know, also a big piece is understanding the nervous system, so this is where I really stepped out of behavior analysis and understanding the nervous systems will and learning. And how it gets affected when a client has experienced trauma, because the body gets affected by trauma. So that’s something that is a part of my practices, trauma-informed perspective, and Yeah the emotion regulation piece is is a big piece as well here.

So we work on things like co-regulation with kids who don’t have co-regulation skills established yet. So that’s really where an adult who’s calm and who’s steady and is regulated themselves helps the child that we’re working with complete the cycle of reg regulation. And then eventually we move towards you know, self-regulation through a lot of different mindfulness practices to build those abilities and skills.

Erika Ng

That’s awesome. Actually, I just want to one thing that stood out there was when you said with the co-regulation having an adult that is regulated themselves, and that is so important. And I, yes. I’ve experienced that myself in those like moments of frustration or witnessed that with, you know, whether it’s school staff, or you know, other environments I’ve worked in, but you’re so right that, that is a key piece of the adult being able to be regulated in order to do that co-regulation piece.

Alexia Stack

Yeah. I mean, 

Erika Ng

Thank you so much for that.

Alexia Stack: Yeah. Like if we think about we’re kind of yeah, kind of, we are socially wired, right? We learn from her social environment and so before we can be expected to self-regulate infants babies, you know, toddlers, they’re all co-regulating with their primary caregivers.

And not everyone is able to do that and sometimes you have kids who, you know, they can’t self regulate, but they also are still needing to co-regulate release. Yeah. Yeah. Yeah, there’s, you know, we work on things like teaching our clients to name their own feelings, a lot of kids who come with histories of trauma, they are not really attuned to themselves.

They can’t necessarily name their own internal states, a big thing also that happens is they often will miss a tribute, the emotional states of other people as well. So they might always think an adult is angry when that adult actually just feels fine and they’re okay for example, but their own trauma history sometimes teach them to process emotions differently.

And another component is like working on establish building strong alliances with other professionals that are responsible for client’s care. So I don’t do any of this stuff on my own without the supportive psychologists or social workers, counselors, the school staff, school personnel, who are all really part of the child’s team.

And they have typically more education and more knowledge and understanding than I do in these areas, and they their voices are really heard as part of the development of plans. So that’s a really big piece for us as well. 

Erika Ng

That’s great. I really respect your perspective on that, because I think sometimes we get a bad rap as behavior analysts of, you know, coming in and seeming like we know it all. But to just hear you reiterate that the importance of collaboration, and understanding different perspectives and taking understanding knowledge and respecting that knowledge of other disciplines that we’re working with. They can only have the best outcomes for our client if we’re working together. So, 

Alexia Stack

Yeah. 

Erika Ng

Thank you for mentioning that. So also, in terms of other alliances, can you tell us a little bit more about your work with parents in particular? And I know that you are an act practitioner and so how do you implement act in, in your work? Is that directly with parents? Is it also with clients, both one or the other?

Alexia Stack

Well that’s one of the reasons why I’m going back to school so that I could do more work directly with parents from an act perspective, so like when we look at act as a therapy versus the way that behavior analysts are, you know, basically allowed to work with it within their scope of practice. I’m really hoping to be able to be able to apply it and use it in both ways, in in the more near future at this point.

So in terms of applying it with the families and with my clients. And so when I would do a lot of work we do actually a lot of work around values and moving in the direction of values. And but those are oftentimes like my youth client values or the child’s values as well as the parents’ values as well.

And just kind of setting up the environment so that whoever we’re working with this point actually come into, I guess, contact with like those things that should allow those behaviors to continue more and more in the future. I guess, without using too much technical, which is something I often tend to default to know, but so there’s a lot of values-based work and setting up and arrange in the environment that we can actually practice that and be successful with it.

And do it more and more basically because we have been successful with it. I do a lot of work in present moment awareness and mindfulness practices like that is for sure within the realm of behavior analysis. And I do a lot with that work with kids, youth, adults as well. And the adults being the adult client with autism for example and present moment awareness practices are a good piece versus things like, you know, diffusion techniques, which tend to fall more within the realm of counselor or a psychologist or something like that.

Like based those are things that I tend to kind of stay away from, ’cause it was really focused on thoughts and stuck thoughts or they call it fuse thoughts within act training. So yeah, I mean, that’s how I apply it at my practice, I get supervision presently in that area. So, 

Erika Ng

That’s great. 

Alexia Stack

Yeah. 

Erika Ng

Well, it’s exciting that you’re going back to school and we’ll have that both of those Avenues, I suppose. You know, to be working a little more with parents and more of a counseling component alongside the client, ’cause it’s true I mean, our model is very different from someone taking their child to a counselor. Where they’re in the child and there isn’t necessarily that, parent training component, but that’s amazing that you already can implement some of that with the values with parents. So, 

Alexia Stack

I mean the other areas are like developing parent positive behavior support plans like so friends that really come straight from the PBS Literature. But that are rooted in a trauma-informed practice, the development of safety plans as well.

So things like that are also a component of our practice understanding what kinds of environmental triggers. Bring up flashbacks and stuff for clients, and so we do a lot of work in that area as well, not in order to treat the trauma, but actually in order to prevent flashbacks from occurring in sessions and stuff like that.

So it serves, you know, I don’t want to be inadvertently triggering my clients and so on. And so that involves working with the parents and working with the children as well and developing plans around that also. So, 

Erika Ng

That’s great. I’m glad you mentioned that because that really just makes it seem, like they made that clear that like we’re not treating the trauma like that you’re working with other professionals on your team. But I think you’re so clearly describing how behavior analysts can fit into that broader team, that is supporting a client and bring something really important to the table, but also being within ours go both of practice. So, 

Alexia Stack

Yeah. 

Erika Ng

Yeah. I’m glad you mentioned that. I’m also just thinking for listeners, I should have when I asked you the question, I said, act but you would reference this earlier, but I’m going to connect to them that act as acceptance and commitment training. I should have mentioned that when I had asked.

So I guess just to start wrapping up how could we be doing a better job in either here. But it’s Columbia, Canada, or more broadly, but in serving families that have experienced trauma, and whose children are going through some behavioral health challenges of some sort. So when those things come together, so, yeah.

Do you have any perspective on that? 

Alexia Stack

Yeah, I mean, that’s a pretty, big question. There’s a lot of different things. So I mean, there’s a funding related issue. And then there’s like, well, what do, what can we do as behavioral scientists? And from a funding related issue, I really do feel so strongly that you know, having provincially funded mental health supports for kids and their families is the only way that this is going to be accessible for everybody.

You know, I am firmly believer that mental health should be treated like physical health. You know, I, if I break my arm, I have a physical trauma, I just go to the ER and I get a I’m cared for, I get a cast and I go along the way. If I have a broken sense of trust with people, because I’ve been emotionally, physically, sexually abused, I’ve been neglected.

There’s no you know, provincially find that support available for that and so, you know, then that has its own huge set of consequences in the long run, right? We have kids who become teenagers and adults who suffer, and struggle with depression, anxiety, suicidal, ideation, addictions, and all that kind of stuff.

And so really ultimately those people who can access mental health services, whether they’re provided by behavioral analyst or they’re provided by a counselor or a psychologist, those families tend to have the financial resources in order to be able to provide their kids with support and treatment and so we ended up with really a two-tiered system when it comes to mental health services.

So that’s one big piece and and the other big piece is working towards behavioral sciences, and us as professionals as behavior analysts being more approachable by the general public and population, being more palpable to other professionals and families as well. Oftentimes I think our persona is such that we come across as being abrasive or harsh or no at all, or unwilling to work flexibly with other people.

And that’s been something I think that’s been, I’ve been working in the field. I think over 20 years, somewhere in that area right now and that’s, I feel like that is, has really counted my entire career in some ways. Where I really wish that more of us would learn to present ourselves in such a way that we were seen as people who can provide, you know, care and treatment and support because many of us are super capable of it.

But I think we get really caught up in the river rigmarole of the science and a lot of ways, so we’re just not very consumer-friendly, you know. Lots of people have been criticizing us and we’re starting to criticize ourselves for that now, but there’s a lot of work to be done in that area. 

Erika Ng

Yeah, you’re right. Yeah. I feel like things are starting to like we are starting to be a little more self-reflective, is kind of the sense that I get but you’re right there’s work to be done, so, 

Alexia Stack

Yeah. 

Erika Ng

I’m glad you mentioned that, so yeah, I guess we’re just about to wrap up, but is there anything else that you want to include that I have either asked you about, or that there is maybe a resource that you want to share with families before we finish. 

Alexia Stack

Oh I think that you know, I could probably share some resources that maybe you can add to the podcast links afterwards. Yeah, that’d be great. And what was the first part of your question again?  

Erika Ng

Any other insights that you might have or things that I haven’t asked you about you wanted to touch on?

Alexia Stack

I think I’ve pretty much touched on most things you know, I think the biggest thing is to really know that, you know, for a lot of people, there’s a lot of darkness, I think, around trauma, but really there’s a lot of light and there’s a lot of hope when you work through it. So, rather than you know, not seeking help, not seeking support, trying to kind of hide, push it away, pretend like things haven’t happened for your child or for your family, but actually moving in the direction of stepping forward and seeking support when you where you can find support is really ultimately going to lead to a lot of positive life changes for many people. And so, yeah. 

Erika Ng

That’s a great great way to wrap up. Thank you for that wisdom. And I just really appreciate you sharing your insights here and the incredible work you’re doing Alexia.

So thank you for the way that you’re serving clients and blazing this new trail with serving clients with a trauma-informed practice. So thank you for that example to us as behavior analysts and for serving families that way. 

Alexia Stack

Thanks so much for the opportunity to speak with you today. It’s really lovely. 

Erika Ng

Thanks so much. Have a good afternoon. 

Alexia Stack

You too.

Erika Ng

The comments and views expressed in this podcast do not constitute or replace contractual behavior, analytic consultation, or professional advice. Views expressed are solely the perspective of the speaker and do not represent the views or position of their colleagues, employer, or other associates.

Please seek out a behavior analyst with BACB website if you would like to receive further behavior consultation. Until next time. Take care.

To keep learning, here’s one of our podcasts you’ll find to be of great help: Remedial Reading And Homeschooling Using Behavior Science (with Adrianna Horne and Michael Maloney)

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