Trauma-Informed Behaviour Intervention Part 3) - Text Transcript

- I'd like to welcome back our presenter for today, Saundra Bishop.

And for those of you who have not joined us or have missed the past two webinars, the recording of webinar number one is already available on the website.

Two and three should be up within a couple of weeks, but Saundra is the Founder, CEO and Clinical Director of BASICS ABA Therapy.

She's also the president elect of the DC Association for Behavior Analysis.

She has more than 18 years of experience working in applied behavior analysis and with people with autism or autistic people, and she's been a BCBA for 11 years.

If you've joined us you know that she's especially passionate about trauma inform behavior management.

And she brings a unique perspective from the personal and the professional view of the issue.

So we're thrilled to have Saundra back with us today, and I will turn the floor back over to her.

- Awesome.

I am super excited to be here.

Also I realize I may not have been muted while I frantically looked for my coffee.

So I'm sorry about that.

So (Saundra laughs) y'all heard a little bit about me, so that's me and my adorable picture.

So this is part three of the webinar series.

And so in the last few ones, we talked about setting events and how they can function, how a trauma event can function as a setting event.

And so we call that a TESE, a trauma event setting event, which is a super important component of what we're working on.

We'll do a super quick review of it.

And so we're gonna talk about how we can use a consequence intervention that addresses the TESE.

We're all also gonna talk about how these interventions are gonna affect our clients, and then we're gonna apply it to our own clients.

It's the same way we've been doing these in our webinars up till now.

Super quick, we've reviewed this before, so I'm gonna speed through.

There aren't content warnings in this training, because it's about trauma, but please take care of yourself.

And so if you need a break, take a break.

And then this is an interactive webinar, so you should expect to be commenting in the chats, interacting.

Otherwise, you're really not gonna get much from this because it's just gonna me be staring at you being like, "Hmm, what do you think about this?" And you're gonna be bored and think it's a terrible webinar.

So if you interact, you're gonna get a lot from it, and also I'll be bored if you don't.

And if you do ask questions throughout, I'll try to answer them, but to the groups to get bigger, sometimes I have to wait till the end.

If I miss your question, feel free to ask it at the end anyway, because I am not ignoring you.

And email me, I love emails.

I have gotten a lot of emails from these workshops and I have responded to like 10% of them, and I'm very sorry, I promise I will respond, but we've had a bunch of client crises and staffing issues.

So I am super behind on my emails, but I like the emails, I care about you, I'm gonna respond.

I'm also gonna use like casual language.

Again, we've talked about this.

If you're BCBA, it might make your skin crawl.

I can operationally define all these behaviors if you want me to, and these words, I'm not gonna, 'cause that's annoying, but I'm gonna use words like kind, mean, anxious, safe.

I use them partially for emphasis and also 'cause they're important, but they can all be operationally defined.

And if you wanna send me an email, I'll operationally define it for you, but also try to do that yourself.

And I'm also gonna use identity first language, we're gonna use, I'm gonna say autistic instead of person with autism for the most part, 'cause that's generally preferred by the community.

Though all autistic people aren't a monolith, so you'll also see me say person with autism and also with all of stuff, be sure to work within your competency and make sure you have proper supervision.

If you're gonna do trauma work and that you're also working with a child's therapist.

All right, victory.

So we are gonna talk about trauma-informed consequences because all this time we say like, the most important thing, right?

Is to prevent a behavior.

And then the most important thing is to teach the kid what to do, instead of the ineffective behavior, right?

Instead of throwing themselves on the ground, instead of doing all of these things, but you know what?

Sometimes that's not gonna work.

And so now we have to figure out what's to do when all of our amazing interventions don't work and maybe it's because they're bad interventions, right?

We wrote bad behavior plan.

Maybe it's because our kid is just having a bad day, maybe it's because we had bad day and we didn't do it right that, right?

There are lots of reasons that an intervention might not work, and so we need to be prepared for what to do.

So generally in the field, right?

If you're gonna do a behavioral intervention, what you do is you reward the replacement behaviors and alternative behaviors, right?

And so if a kid, right?

Wants your attention, then you're gonna reward them waiting the alternative behavior.

And you're gonna reward them saying, excuse me, right?

You're not gonna reward the ineffective behavior of them throwing themselves on the ground, right?

We're only gonna look at the immediate observable behavior of them throwing themselves on the ground.

We're not gonna look at any else, right?

We're not gonna look at their feelings.

We're not gonna look at any of that, 'cause it doesn't matter.

We can't tell about internal events and then we're gonna look at our past learning history, right?

What's happened before when they've thrown themselves on the ground and we're gonna say, well, mom has always stopped that conversation and paid attention to them.

They do it for attention, right?

And so that's what the official intervention process is, right?

And it's not wrong, right?

It works, right?

Generally speaking, the kid is throwing themselves on the ground to get attention from the grown up while they're talking to somebody else, right?

That is a factual ABC event, right?

My neurotypical five year old does this, because we have four kids in our house, and sometimes it's the only way she can get our attention.

However, if that's my only intervention, well that's nonsense, right?

We should do all the things we've already been talking about, right?

We can teach her to come and hold my hand.

I can pay more attention and make sure I look around more when there are kids around, right?

There are other things that we can be doing.

With our kids with trauma events though, with these TESEs, our past learning is much more significant around these unconditioned reinforcers, right?

So when we talk about unconditioned reinforcers, we're talking about food, we're talking about attention, we're talking about sleep, right?

We're talking about these things that are so powerful that we don't have to learn that they're powerful, right?

And so those are not things that are easy to train out of a kid, right?

And so we can't just reward and ignore, for a kid who's experienced trauma around unconditioned reinforcers.

And so when we're doing these ABA interventions, no matter how hard we try to do these traditional interventions, they're not gonna work, and they're gonna get worse and they're gonna get worse and they're gonna get worse and we're gonna continue to retraumatize these kids.

And so that's where we wanna look at trauma-informed consequences.

So now we're not gonna give a cookie when they hit you, right?

That's still not gonna happen, right?

But instead though, we're going to do these additional things, right?

And so a kid, right?

Wants you to give them a toy, right?

You're not gonna hand them the toy, but instead we're gonna do this basics intervention and you can see how clever I am because my company is called BASICS.

And so I came up with an acronym that's BASICS, which also might be confusing, but also I'm gonna go with I'm very clever.

And so when we look at BASICS, that's this acronym that means break, always reinforce, safety, I wonder statements, calm, silliness.

And so what this means is that we wanna give kids out, right?

We want to be giving kindness to our kids when they're struggling and having a hard time.

And so the first thing we wanna do is be sure that we always have the opportunity for a break, right?

So we want our kids to always have an out.

There's gotta be a way that kid who's crying on the floor, no matter what the reason, if they're crying because they want escape.

Well, you know what?

Let them have appropriate escape by saying break, right?

Allow them to get out, because there is no reason that we need to have a power struggle until we dominate these children into submission.

So always have an out for the kid.

For always reinforce, right?

Always reinforce our effective behaviors, even if an ineffective behavior has happened, we wanna be sure we're reinforcing the effective behavior.

Now we always run the risk, right?

That we're gonna chain the ineffective behavior with the effective behavior.

But that often doesn't happen, right?

We're always afraid of that, but usually it doesn't, right?

Now that's gonna happen if you say no, and then they tantrum and then you say yes, and so, but then you can still reinforce things that they're doing, right?

So when they first, you know, if you say like, no, I'm sorry, you can't have the toy right now.

And they fall out, right?

They lay on the ground and kick their legs, right?

Then you're not gonna give them the toy, right?

But you can reinforce when they sit up, you can reinforce them using their words, right?

So you can give act reinforcement.

You don't have to just wait them out until they're perfectly calm.

You can reinforce them using another skill.

You can reinforce them going to another toy.

They don't have to be perfectly calm.

You also wanna use safety.

And so safety is everything from removing dangerous objects to reminding kids that they are safe and referring to those materials that we created for those setting event interventions, right?

If a kid starts to escalate, because we know that they've been denied access to food, what we can refer them back at that point to their meal charts, because we've created these tools to address that.

I wonder statements are things that are really cool.

I love I wonder statements.

You've gotta make sure that it's not gonna annoy your kid.

Like I have a kid we work with who hates I wonder statements.

And they'll just be like, "Why do you keep saying that?

I'm right here." But are kids love it, because the thing about I wonder statements is that you can talk, but the kid isn't required to answer you.

And so you would say something like, oh, like, I wonder if you had a, if, you know, if you had a bad day at school, or I wonder if you're really mad at me, or I wonder if you're feeling hungry and you're worried about what's for lunch and you just kind of talk to the air and sometimes they'll be like, "Yeah." Mostly they're like, "I'm not hungry, I just hate you." And at that point it'll opens a dialogue 'cause you can be like, oh, "Well, that makes me feel sad, but why do you hate me?" And then they'll talk to you about what the problem is.

The other thing is to be calm.

So to remain calm and not calm and non-emotional so that you're not escalating the situation and then silliness.

So again, you have to know your student, but you can do something unexpected or give a direction in a funny way.

I had a student who used to have, this was like early on in my career.

And so he used to have a direction when he was upset that he had to sit on the floor, which I would not do as a direction anymore, but that was his direction and he would never do it.

And so one time, I gave him an imaginary chair and we sat in imaginary chair together and he did it and it's great.

And we sat in imaginary chairs from then on.

We had with the teenagers, I'll do a lot of like, we have to do a task and I'll just be like, "Oh my God, it's so terrible.

How will we ever survive?" And then I just like act so dramatic and that finally they're just like, "Oh my God, you're so not cool and so not funny, you're so ridiculous," that they'll just roll their eyes at me and like do what they're doing.

But that only works if that's your personality, I like wrote it into a behavior plan once as an example of silliness with this teenager.

And then the therapist was like, "Yo, this is so annoying." (Saundra laughs) I was like, no, no, no, that's not what I meant, if that's not no, and it was just like one of those things that I was like, okay, wait, I have to not write it as a quote of what I say.

I have to write it more of a essence of what it is.

But also some kids are just gonna be so mad if you act silly while you're doing an intervention.

And so again, these are just things to kind of respond to a moment in time.

And so these are some just examples of things that I just talked about.

And so you can look at these when you get the slides.

So you're not tailoring the basics consequences to the function, you're tailoring them to the setting events.

Now a lot of people, this makes them squishy, right?

Because they kind of feel like they're reinforcing, right?

But they're not, 'cause you're still not giving them the initial thing, right?

You're not giving them the cookie.

You're not giving them the specific toy.

And in some ways you're giving them attention depending on what the issue is, but you're not giving them, if it is that you, depending on what it was, then you're gonna like, I wonder at the wall, or you're going to give the attention in more of a discreet way.

You're gonna offer them the break.

You're gonna do those things in a little bit more of a less interactive way, but you're still gonna do it with kindness.

But you wanna watch your data, right?

If you find that your data shows that there's an increase in behavior, right?

Then you need to reassess which one of these you're gonna do, 'cause you're not gonna do them, right?

You're not gonna do all six of these at one time because you're just not gonna have the capacity for that.

So you're gonna pick two or three that seemed right, right?

I always do break every single client there's always break, right?

And then there's always reinforced, so those two are always in every one.

And then there's like one or two that are like useful for the other kids, right?

And so you're gonna be able to kind of tease out.

And so if you realize that like, whoa, there's like a huge increase in behaviors, then you're gonna be able to see like, all right, well, one of these things I'm doing is actually reinforcing the behavior and not addressing a setting event, but it rarely happens.

We think of it as universal trauma precautions, right?

Somebody used that term and it's just like, love it, and it's in the research and stuff.

And it's the idea that we don't always know what the trauma is that our kids experienced.

And so if we can just assume that all kids had trauma and that a follow through without allowing a break, that if we don't allow kindness and some ability to support a kid that we're retraumatizing a kid, that we need to be compassionate.

One of my greatest regrets as a clinician, was I was brand new.

I was six months out of being certified.

And I had a client who I had no business working with.

He was 17-years-old, 220 pounds, looked like a football player, and his behavior is that he would scratch his mom's face.

And the reinforcement seemed to be seeing her bleed.

And it really like, it sort of presented itself like an OCD behavior.

Totally outside my scope, shouldn't have been doing it.

But we tried all sorts of things, right?

We tried a ball with like, like flesh colored Play-Doh that was red, scratch it to see the red.

We tried her putting like ketchup on her face, her wearing like a baseball cap.

So he couldn't get to her.

We tried, me doing physical management, which I was like, which I don't even do anymore.

But at the time I was pretty good at, but he was too big for me, me getting in front of her, because he would never engage in aggression with me.

I was doing direct therapy with him as a BCPA.

And so we did everything, right?

And he was about to get institutionalized, right?

'Cause he just couldn't be safe at the house.

And so I decided I was gonna do a punishment procedure, right?

And we were gonna do contingent exercise, right?

So that's if you don't know, it's like stand up, sit down, or touch your toes or something, right?

So not a like big deal.

And so I told this guy, and he couldn't talk, he didn't talk.

I told this guy that he needed to stand up and sit down four times every time he scratched his mom.

And so I was at their house and he scratched his mom and I was like, "Hey, stand up and sit down." He did it, and he did it 'cause he trust me.

And he worked with me and we had a relationship and then an hour later he got up and he scratched his mom again, and I say stay up and down and he ran from me, and I chased him, to do my follow up.

He slammed the door, and I opened that door and he threw me on the ground, just rag dolled me and I went down in the fetal position and he just clawed at my face and I had scratches and I had to call for help, and his mom had to pull me off of me and I was bleeding, and she says, I'm taking him to the doctor.

He has a doctor's appointment, and I said, "No, you have to take him to the emergency room.

He is not safe.

He has to go to the hospital." And she said, "No, I'm taking him to the doctor's appointment." So she takes him to the doctor, turns out he has Lyme disease and he was suffering from severe painfully Lyme induced arthritis.

And I made this young man sit up and down and up and down and suffer intense pain.

And he did it because he trusted me.

There's nothing I can do about it, right?

Except for know better and do better.

And talk to you all about that experience about doing an intervention that felt very mild, that had intense consequences.

And so that's why we wanna look at these trauma universal precautions.

So does anybody have any questions about this part of the intervention before we go into our examples or comments or anything?

Okay.

- [Shirley] I do see Paula has a hand up.

Paula, if I can enable your microphone, do you want to enable your microphone?

- I don't know if that's an on purpose hand or not.

- [Shirley] Oh, I'm not sure.

(Saundra laughs) Okay, Paula, if you want to jump in, if not, we'll carry on.

(Saundra laughs) - Melissa likes the acronym.

Yeah, I like the acronym too.

It's helpful for staff also.

We put it in our behavior plans now to help them remember, even if they're not break, safety, things, it just kind of helps them remember that it's not just follow through, that there are ever, that there are other things.

(Saundra laughs) Thank you, Laura, for acknowledging my cleverness.

(Saundra laughs) All right, cool.

Yeah, and so just too, is that for this consequence interventions, for the trauma-informed consequence interventions, we think of them as being something that stops the behavior, right?

And we say like in the moment, it might not actually actually stop the behavior because we're not reinforcing it so it can get worse, but over time, but when we do these kind interventions, the idea is that actually, hopefully they will stop and we won't get those extinction bursts.

And so that these trauma-informed interventions are actually based on de-escalation, redirection and frankly, kindness.

And so we can avoid those big blow ups because the kids have a way of escaping in a functional way.

It's empowering them to self-advocate and say like, "Okay, yo, I do not feel good, I do not like this." And to have adult to help co-regulate them, which is what we all do, right?

I cry, and I go ask my partner to hug me, right?

A neurotypical five year old is upset and gets help from their parents.

And again, we're not giving them the cookie, so they're not getting reinforced.

And now there's always the chance, right?

That you get the secondary reinforcement, right?

I want the cookie, I don't get the cookie, but then I get attention, and now all of a sudden that's maintained by attention.

It's always possible that happens, so you gotta watch your data, but it usually doesn't, just gets people's needs met.

And we want our kids to come and get hugs when they're sad, that's not like a problem.

So when we look at our interventions, right?

these are our friends that we've been watching in our past two webinars.

And so if you weren't here, people like, "Talk about it super fast." But for the most part, you really need to have been at the past webinars to kind of keep up.

But we have been talking about Markos, and Markos is four years old with two vocal words.

He says peepee and cookie.

He's potty trained, ambulatory, and has age appropriate motor skills.

And he's diagnosed with autism.

Whenever Markos sees a cookie, he jumps up and down and screams and his mother gives him a cookie.

The data show that he's more likely, this is more likely to occur if he didn't eat breakfast.

And we've just learned that Markos experienced early food deprivation.

And so when we look at this, we wanna look at our, what we could use for our BASICS consequences.

Now here's the little chart that this is the whole section for all of the consequences, which is what we're gonna go through today.

But I'm just pulling out the section here for BASICS.

So that's what this is here.

But this goes, this is the whole section that we're gonna look at today.

So if we're just looking at the trauma consequences, so what we can do for him, right?

So he is jumping up and down and screaming, he's super upset, 'cause he wants the cookie.

So for break, we can just offer him a break and be like, "Yo, you look upset.

You wanna go take a break," right?

For always reinforced, if he starts to calm down, we can praise him.

We can also give him a cookie if he requests it.

Because if you'll notice in this, he was never told no to the cookie.

He just saw it and jumped up and down and screamed.

So we can give him the cookie for manding, right?

Giving him the cookie for manding is not a possibility if we told him no and he jumped up and down and screamed, but he wasn't told no.

So if he mands for the cookie, even though he is yelling at us, I would wanna give him that cookie.

For safety, we can point to his food schedule 'cause if you'll remember, because Markos had early food deprivation, we had a food schedule for him and we had anytime food to help relieve his anxiety about food.

And we can also move away because we wanna make sure we're not standing next to him while he's kicking.

I had a student who got expelled from his preschool because he kicked his preschool teacher in the face.

He was like two.

And my first question was, was why was her face next to his feet?

Because he's two.

And so if a kid is upset, don't put your body where their feet are, right?

And like, whatever.

Sometimes they're gonna like chase after you, and sometimes you're caught off guard, but generally speaking, don't put yourself in body's reach if they are acting aggressive like that.

So just be aware of that in the environment.

For I wonder statements, you could say, "Oh, I wonder if you're nervous about when you're gonna eat next.

I wonder what would happen if you said cookie, please." And for calm, just be sure remain calm and don't get agitated with this tantrum.

And then for silliness, you could grab the broccoli from his anytime plate and eat it like ice cream.

Does that all make sense to see how it plays out with the scenario that we've been using?

Do you all remember the scenario?

And anybody have any questions about it?

Cool.

All right, and I just like that it's just really clear and it really targets all the things.

Okay, and so, and again, here's the answers so that you could review it when you are, look at the slides.

So let's look at Hawa.

So we talked about Hawa last time.

And so Hawa's 10 years old and speaks in full sentences.

She has delays in emotional regulation and sensory integration, and she has as a diagnosis of fetal alcohol syndrome.

When she's asked to clean her room, she runs from the room.

The majority of the time the babysitter says, "Fine, I'll do it, nevermind." We observed that when she slept only three hours, this increased the likelihood of the behavior.

We have just learned that Hawa is in foster care and experienced parentification.

This means that before she came to her foster family, she was responsible for caring for her two younger siblings, feeding them, taking care of the house, and getting them to school.

So what is something that we could offer as a break for her?

Oh, okay.

Yeah, so just to break it down.

So her antecedent is that she's asked to clean her room.

Her behavior is that she runs from the room and the consequence is that the babysitter says, "Fine, I'll do it, nevermind." So what's a consequence intervention if she runs from the room?

So what could we do for break?

Are people confused or did people wander away?

Yep, do you wanna clean your room now?

Do you wanna wait for five minutes?

Have a safe place for her to go.

You need to chill for a little bit, yep.

Tell her you need to do a break.

Yeah, Laura.

So Laura suggests that we do something fun together.

You don't want to make the break too exciting.

A break is something that's like a little bit more independent.

Though I have to tell you.

So I went to a workshop.

It was like five years ago and this woman presented a paper and something she did at her practice where she offered unlimited breaks, so we offered limited breaks.

Kids could take breaks as long as they want.

We did them in five minute increments though.

So every five minutes we check back in and say, "Oh, are you ready to work?" But they can say no.

So they could take a break the entire three hour session.

Nobody does them, and if they do, they end up being sick or something.

And so then we're like, oh my gosh, I'm so glad we didn't make them work because how terrible it would've been for everybody 'cause they would've been miserable the whole time.

So we offer these unlimited breaks.

It's awesome, it's great.

We love it.

But all they can do is just kind of sit and just chill by themselves and relax.

This person presented this paper and talked about in her practice that they let them and play on their iPads on their breaks, and that it worked and that the kids did the same thing, that they would come back and work, and I can't find the study anywhere.

And she was just like blonde BCBA from up in the Northwest somewhere.

But I can't bring myself to do it, 'cause I can't believe that it's true, and because I can't find the study, I can't find exactly what the process was.

So somewhere in the universe, somebody lets them take their breaks, doing their favorite thing in the universe.

We don't let them do that.

They just have to sit.

But apparently it works and there's some research backing it up.

I just, I wanna believe it's true, and I would love to do it.

I just, with electronic addiction, I just can't see how they can get off the device.

But anyway, that's my like, if anybody finds that study and can send it to me, I would be your best friend forever, but I cannot find it anywhere.

So anyway, so yeah.

But so in the context of what I know, we wanna make the breaks not too exciting, but yeah, but a time in is a common practice and it's fine, right?

It's okay as long as you, you are going back to the task eventually.

Instead of like, "Let's go and get ice cream." If it's like, "Hey, can you help me do the dishes," or something like that?

Let's go for a quick walk and figure out what's going on.

I think that that's fine.

Always reinforce.

So what are we gonna reinforce her for?

Coming back to the task?

Sure.

Any attempt, she picks up something.

We also wanna just reinforce a calm body, right?

Asking for help, calming down, engaging.

Yep, anything she does.

Yeah, not running, if she just stops running.

Hey, thanks for chilling.

Thanks for just being present.

I know this is hard.

Let's look at the rules card.

Oh my gosh.

Thanks for looking at this with me.

Thanks for being with me while we do this.

Yeah, that is nice.

All right, so safety.

What are we gonna do to make sure everything stays safe?

Give her some space.

Don't block the doors.

Yeah, and so that one's a little counterintuitive, right?

So in this case, right?

So you could block the doors.

Somebody could say that that's a safety thing to prevent her from escaping.

But I also, I would agree with that.

You don't wanna block the doors because she's more likely to injure you.

Now she's 10.

So depending on the situation, standing in front of the door could be a solution, right?

'Cause if you know she's not gonna push past you, right?

I have some students who I would say like, "Hey, just stand in front of the door," and they're gonna like stop.

I have other kids who wouldn't.

I mean, even my own kid when she was seven was like, I'm gonna run away.

And I was like, "It's quiet time, you can't run away until after quiet time." And then she was like, "Okay." (Saundra laughs) You know so it just depends on the kid, but yeah.

I think also just like watching the exits, making sure that the keys aren't by the door.

If she's a really precocious 10 year old who might grab the car keys.

We had a client who just ran out the building and who wait to call the police, so being ready to call the police, even though we had eyes on them, we were concerned that they would dart.

Enhanced choice model, right?

I'm gonna save this.

Ah! Oh, no, it just broke my screen, I'm sorry.

Okay, let me get back to saving.

I clicked on your link and then I think I stopped sharing.

- [Shirley] Yep, you're still sharing, just not the PowerPoint.

- Oh, okay.

Well, then, let me save this file and then share again.

Okay.

- [Shirley] Perfect.

- Crazy.

All right, I wonder statements.

I wonder if it feels a big task.

Laura Crane is gonna win the award for most involved.

I wonder if this is too much.

I wonder if you would like some help.

I wonder what would happen if you asked for help.

Yep, yeah, you guys got the I wonder statements.

I seriously love I wonder, because it really takes the pressure off having to respond 'cause they can just be silent and then no direction's been given.

There's no expectation that there's a response, and it also gives them some control, 'cause they can be like grumble, grumble, grumble, I didn't respond.

But also you don't have to feel like you have to do follow through.

I wonder where we should start first.

Laura says she uses this technique often.

Yeah, my own eight year old gets so mad if I ever use the I wonder statement.

I have to be really careful in not to, 'cause she will, she'll be like, "I am right here.

Why are you doing, I know what you're doing." (Saundra laughs) Calm.

This one's actually kind of an important one, which people don't usually come up with.

But it's pretty obvious once I mention it, Megan says that she hates I wonder statements.

Yeah, some people super, super, super do.

Julie says, tell them to relax.

It's not the end of the world, or you will relax.

Don't chase her.

Yep, Nancy that's the one that I was thinking about, is that you gotta do your speed walk and not the run walk.

Now that is different if they're actually in danger.

But once you start running, then you're gonna turn on the fight flight freeze response, or it's gonna become the most fun game in the whole universe.

But again, it's just gonna depend and also they're gonna be faster than you most likely.

So, yeah, and then once you catch them, you have to think about what are you gonna do?

Are you gonna tackle them?

What's your plan once you catch them?

Validate while minimizing your own emotional reactions.

Yep, that can be really hard particularly if they're triggering you, right?

If it's like, oh my God, I do all of these things in this house.

You leave all of this mess in the whole house.

I've made this rules card for you that says that like, all you have to do is clean up your room, and I clean up the bathroom, I clean up all your dishes.

The BCBA told me that if I clean up everything else in the house that you trash and just have you do your room, and now you're refusing to do your room and threatening to run outta my house and steal my car keys, like WTF, right?

That can be really hard to then be like, I understand that you must be feeling overwhelmed, right?

And so that can be really hard for families.

And it's super important to acknowledge that because it's really frustrating to have put in all that work and that sacrifice, and then still have to honor your kids' trauma when they're wreaking havoc on your life.

As much as you love them, as much as you're willing to do the work to then have to still do more is really taxing on the parent.

And so this calm one is the hardest for parents, but also the most important.

And so really, really, really validating that.

And also telling parents that, I keep saying this, I think that it's like, but it's real life, right?

And letting a parent know that if they mess up, it's real life, and that can apologize to the kid and just move on.

Okay, and silliness.

(Saundra laughs) Yep, we're clean underwear as a hat, which is good for the 10 year old set.

Turn on music and dance.

Yep, this is another one.

You were going to be shocked to know that my MO as a therapist is dorky.

And so, yeah, so this is the, this is either the me laying on the ground and being like, this is impossible, It's too bad, there's no way to get this room clean or I'm gonna dance around and be annoying.

So the silliness would have something to do with the activity that you wanna have happen.

So there was something assume the silliness should have some connection to the unwanted behavior.

So it would have some, it sort of would have, it would have, think of it as a way to shock out of the behavior.

So it could be sitting in the imaginary chair, or I'm trying to redirect you to the vegetables, So I'm gonna eat the silly vegetables.

Sometimes like this one, you have to be really careful of, depending on who the kid is, because you might have a kid who get startled or who's gonna feel bad, but there's been a time where I've pretended to knock over a chair, bump into a chair and knock it over just to have the loud noise to kind of startle out of it.

But again, you would not wanna do that to a kid that has sensory issues or who's severely empathetic, who's gonna feel really, really sad if you got bumped into a chair.

And so it's just about I'm changing the mood, I'm being unexpected about what's happening and I'm making this a little giggly.

Yep, puppets are funny, silly songs.

Yep.

Does that answer your question?

Your name is initials, so I don't know what to say that you asked if the behavior, the silliness has to be about the ineffective behavior.

Okay, cool.

Okay, so now we're just gonna kinda look at the analysis of the behavior and sort of our whole kind of behavior plan and whatnot that we've created.

And so this is what the whole intervention looks like.

So this is, I'm gonna go through this kind of quickly.

I know it's very, very tiny, but we're only gonna, we're gonna move over to another slide, but this is now what Markos' intervention looks like, right?

He sees a cookie.

He jumps up and down and screams.

He gets a cookie.

His access is function.

I'm sorry, his function is access.

We know this is more likely to happen when he doesn't eat breakfast.

And that his trauma history setting event, his TESE was food deprivation.

So we put in amazing intervention in place for antecedent interventions.

We're gonna hide the cookies.

So he is not gonna see the cookies to jump open down or scream.

We're also gonna make sure that he is fed breakfast.

So it's less likely to happen anyway, 'cause he is less likely to be hungry.

We're also gonna address the anxiety around his food deprivation by making ensure he has a food schedule and access to vegetables all the time, as in any time food.

And hopefully, if we can handle all these things, we've prevented the behaviors from happening in the first place while we've decreased the anxiety there, and hopefully, prevented the behaviors from happening most of the time, we're teaching new behaviors.

So we're teaching a replacement behavior, right?

Which is to ask for a cookie.

We're also teaching a replacement behavior to address the setting event.

So we know when he doesn't eat breakfast.

So we're gonna ask, teach him to ask for breakfast.

We're feeding him breakfast, but we also wanna teach him to ask for it himself so he can do it more independently.

We're also gonna teach him this alternative behavior, which is to wait when he sees a cookie.

And then finally, we're gonna teach him a TESE setting event replacement behavior, which is to teach him to access this stuff that we've created for him.

So we're gonna teach him to go look at his foods schedule and we're gonna teach him some cleaning, some calming strategies to take deep breaths.

Hopefully, if he's able to do all these things, we're also not gonna see these behaviors anymore.

We're preventing these behaviors.

We're teaching him how to get his needs met and we're teaching him ways to access these setting event interventions that we've created in case we forget to do them.

And then finally, we created trauma-informed consequences, right?

He's still not gonna get his cookie for tantruming.

But we've created an intervention that's gonna allow him to get access for it, for asking in a more, asking for it using his words.

And then we've also created a trauma-informed model for how to address it once he does get escalated and upset.

And so this is a pretty cool model that we've created.

And so then as we look at it, we wanna look at how this is, what kind of effect this is gonna have on him?

And so if we think about the effect of the traditional intervention, if we're not doing the trauma-informed intervention, if we just are making sure he doesn't get his cookie, so we're teaching him to ask for a cookie and then we're not giving him a cookie when he tantrums, right?

So he is gonna wait him out until he stops tantruming, right?

That's the traditional response.

Well, how's that gonna affect him?

Right?

Ultimately, it's gonna increase his food insecurities.

We're gonna see an increase in behaviors because his motivation for food is so high because of his history of food deprivations.

We're gonna get increased anxiety, and it's just going to reinforce his trauma experiences.

That is not going to be an effective intervention, and that is not going to be a kind intervention.

His trauma consequence history is that he wasn't fed.

And probably when he engaged in these big behaviors, he was probably fed to stop starving, right?

So we're not just talking about him throwing a little a fit, 'cause his mom gave him cookies, right?

We're probably talking about this being a historical response from when the original trauma happened.

Now we dunno for sure, but it's likely, and that this behavior was something that was potentially life saving.

And so if we think about what the effects of our trauma informed intervention is, right?

Now, we've done all these things, right?

The setting, the antecedent interventions, these new behaviors that we're teaching him, we're being kind in our consequence interventions.

So now Markos is gonna feel safe.

He's gonna know that he's gonna get food and he's going to become less reactive around food.

It has a complete opposite effect than how we would traditionally handle this behavior.

This exact intervention can be put into place even if we didn't know that Markos had a food deprivation history.

Maybe we would miss the food schedule and the anytime food.

And if that piece was missing, we would still have feeding him breakfast, hiding the cookies, and we would still have the trauma-informed consequence if we were using universal trauma precautions, and it would still meet his needs if we had an unknown trauma history, and we would avoid potentially traumatizing a kid who had already experienced trauma events.

Any questions about that?

What are you guys thinking?

Do you think I'm a hippy dippy behaviorist?

Do you guys think that, do you buy into this?

Do you understand this questions about this?

This all stuff you already knew and you've wasted your last hour and a half?

Ye-hey, everybody likes me.

(Saundra laughs) Awesome.

Zanab, is that how you say it?

I am going to send you all the slideshow itself.

Would you still like me to go back to the other slide or is that gonna be good enough for you?

Okay, cool.

Did I say your name correctly?

So if Markos remains reactive around food, then we should be having an actual therapist involved or a feeding therapist and throughout the whole process, that should be a part of the intervention also because food reactivity is a mental health issue as well, and so this is just a sort of a foundational piece for an intervention, but like true food reactivity needs to have other medical intervention.

Yeah, Ashley, so the third piece of the intervention.

So Ashley asks if we would be tolerating them to keep the cookies present.

So the third thing is alternative behaviors, and so that is, is the one alternative behaviors is about like what we wanna see.

So that is a piece of the intervention.

We wanna get this other stuff solid first though.

So that's always a part of an intervention, but I don't want it to be the priority.

It needs to be like a secondary piece because a kid isn't going to be able to do that piece until they feel safe around the other stuff.

And so that should definitely be a part of your behavior plan, a part of your treatment plan, a part of your goals.

But if they're in high stress, they're not gonna be able to do it.

The thing that I see so much in like behavior plans and treatment plans and things like that at schools is they'll say, the replacement behavior is he'll tolerate cookies being around.

(Saundra laughs) It's like, oh, that's not a replacement behavior.

Replacement behavior is asked for cookies.

And so, and so, yeah, but no, you're that yeah.

That, yes, he has to learn to tolerate cookies.

And a lot of times they just will, by learning that they can ask for it when they need it.

Kind of just the same thing that kids will just stay in session and work when they know they don't have to, or kids will like stem less in sessions when we like teach them to do other stuff.

And so we never target stems because it's their human right to calm themselves.

But they're less anxious when they realize that they're having fun.

So I do not use SBT.

It is a fine strategy.

We just use a different strategy, but we just use a natural environment teaching style.

And we do like a traditional, all natural environment with a traditional prompting, but we always allow escape.

And so we don't do a like your way, my way, we always allow, so the therapist is always responsible for like running goals, but the kid can always say no, and we find that the student eventually will decide to come back.

And if they don't, then there's a problem with the goal or what we're doing.

And so it's not perfect, and we don't run that with full fidelity.

We're working on that because like, you know, we have texts in the field and you know, so we're working on making sure that that's being done correctly a 100% of the time, but that is our goal.

What happens if he doesn't replace the screaming with asking for the cookie, but begins grabbing the cookie for himself?

Do you repeat the intervention?

Well, at that point, well, I mean, at that point, we would had the antecedent of like having the cookies away if it was that big of a problem.

And we would be teaching, if we put the cookie out and we were trying to teach him to say like, "I want a cookie," and he just started grabbing the cookie.

I mean, if that's the case, it's kind of a functional behavior, you know what I mean?

I think that that's the thing is that we just need to figure out, if a kid is able to independently do something, it such a complicated thing.

And it would be, I think it's a little bit of a kind of a bit of like what ifs thing, it's a little hard to answer.

But we're also really stuck on adult mediated things.

And so it's a little bit hard, because really, we shouldn't leave a pack of cookies for a four year old on a table period, right?

Four year olds are always gonna steal the cookies on the table.

And so if we think about age appropriateness, it's not really a fair expectation to expect a four year old to not open cookies on a table ever, right?

Neurotypical four year olds will open cookies in a grocery store shelf, too.

You know what I mean?

Not all of them, but that is a naughty thing that a four year old might do, right?

And so we also have to think about what's age appropriate.

And then there's also this idea of we have to stop having things adult that we have to make things be adult mediated, or we have to stop having them adult mediated, and so that's this weird thing.

So when we teach language, right?

Sometimes we're very rigid on like, well, no, they have to use their word.

To the point where we ignore the communication strategies they have.

So we tell parents, ignore them when they drag your hand and take you to the refrigerator.

And I've done this, I have absolutely done this with parents and I am horrified by it when the child can communicate to you, and sure, we should also teach them the language to say whatever word it is they want.

But all of a sudden we're taking away their voice.

We're gaslighting them because all of a sudden their parent has to pretend that they don't know what they're saying.

And how awful is that, that we're doing it?

And we think that that is good for them.

So in the same way, right?

If this was a 12 year old and the cookies were on the counter.

Well, probably the 12 year old to just grab the cookies and not randomly sign cookie to their mom, because if you're gonna leave cookies out, then I should be able to eat the cookies.

So anyway, so that's just kind of my tangent.

And obviously, it's gonna be much more nuanced based off of the kid.

Thank you for listening to my TED Talk (Saundra laughs) during my webinar.

Next case.

So these are the answers for later.

Okay.

So this is Hawa.

And to remember what an amazing intervention we came up with for Hawa.

So Hawa is asked to clean her room and she runs from the room and the babysitter is fine, I'll do it, and so the functions escape, right?

We know that her setting event is that she slept for three hours and that her trauma events, parentification.

So we came up with this antecedent intervention, is that we could just say, "Don't clean your room." But that's probably less practical than giving her a checklist, priming her, or asking her to do less, right?

Instead of saying clean your whole room, we might say like, "Hey, pick up all your socks." Because we know she's tired, we wanna make sure she gets to bed on time.

Maybe we'll set a alarm on her iPad, so it turns off specifically, or maybe we'll do some priming about what time is bedtime.

And for her parentification, we really wanted to be able to reduce that anxiety.

So we wanted to make sure that there were family rules that would identify kid jobs and grown up jobs, and then we would also be able to teach her some deep breathing.

We wanted to make sure she had some good new replacement behaviors.

So we could teach her to ask for a break, or we could teach her to say, "Nope, I don't wanna do it." For her replacement behavior, addressing the setting event, her being tired, we could have her learn how to go to bed at 8:00 pm.

Our replacement behavior is obviously that she would, or alternative behavior is that she will clean her room.

And our TESE antecedent intervention replacement behavior is that she'll look at her lists that we've made for her, and that she'll take her deep breaths.

It doesn't matter if we teach her how to do it, if she can't do it.

And we have our amazing trauma-informed consequences that we have in place.

So when we look at our traditional consequence intervention, what is it that we would do to traditionally, based off of her behaviors?

The traditional consequence intervention.

So if she started to run away, what would our traditional behavior plans typically say?

To do?

Before I taught you all these amazing interventions.

What would a plan usually tell you to do?

Somebody says lose privileges.

So that's typically more of a long term thing.

So typically a consequence intervention is what happens immediately after the behavior.

Yeah, so block for her from leaving, wait her out, redirect.

So it would be a follow through until she finishes.

It would be being in her space.

It would be pointing her back to her room, prompt her back, keep doing it until she does it.

Don't let her escape, don't let her get out of it.

Or she's gonna learn that she runs away, she can get out of tasks.

You do not want her to think that she can do that.

Now, based on the fact though that she has parentification, how do you think that a follow through like that, where you're blocking her way, that you're pointing her to task, that no matter how much she objects or how much she cries or how upset she gets, how angry, how do you think that that is gonna affect her?

Got to be traumatized.

Won't feel understood or validated.

Won't see herself as part of the team, still on her own.

That's a good one.

She also won't see any way out of doing household things.

Lack of trust, right?

Yeah, all of those are great.

Not gonna feel good.

And her behaviors are gonna escalate, right?

It's not gonna get better.

We call that an extinction burst.

But for somebody who's had trauma, they're gonna get worse and worse and worse.

They're not gonna just go like a little teeny poop of extinction, right?

Because the value of getting out of it is so high.

And so if we think about what she's gotten as her consequence history before she came to this foster home, what did she get out of this behavior if she ran away?

If we talk about it from a theoretical perspective, what would be getting out of this task mean to her?

She could be a kid.

She could get reprieve and she wouldn't be responsible, right?

So this behavior has more value than just not having to clean her room.

And so if we do all of these interventions that we just talked about, which are all behavior analytical, right?

So those are you who are BCBAs, those are you who are like down with the ABA science, right?

Or all people who are like, "Oh, ABA is bad," but you can see, right?

This is all behavior analytical, right?

I am following our science, just doing it in a nice way, right?

And so if we look at these things, what do we think?

What are the effects of this trauma-informed behavior analytic intervention?

Also a side note, there's plenty of bad ABA.

I just mean that, that ABA can be done responsibility, responsibly, but yeah, so what are the effects of this?

She feels respected.

There's compassion.

She feels safe.

She feels empathy.

She has a voice.

She was validated.

I think she's likely to actually learn the skills because she's calm enough.

She's given the space to learn those skills.

All right, any questions before we do one together?

All right, so just a reminder, this is what the whole thing looks like.

So y'all have been working on this this whole time, but we're just gonna do the consequence intervention together.

And so if you haven't been doing all of the other sections, that's fine.

You will be able to do this part without having done the rest of the workshop, but we're gonna come up with your basics intervention, and so we're gonna work through it together.

And so what's gonna happen is I'm gonna say, and if you've done this before, you'll do it.

I'm gonna be like, "Hey, what is your B?" And you'll put it in there, and I'll be like, "What's your A?" And you'll put it in there, and then I'll make comments like we've done.

This is really valuable.

I really recommend you do it, and it's valuable for you, and then it's also valuable for other people to hear my comments that I make about yours.

And so we're gonna go through this and, yeah, so please do this and we'll get going.

So the first thing is just think about a kid that you work with.

Ideally, it's the person who you've been using in the other workshops, but if there's somebody else you wanna talk about, that's fine.

And in the chat, in one line, write the antecedent behavior and consequence and the function that you are gonna be talking about.

So Marcus, sees a, oh, and please don't put any identifying information.

So student sees a cookie, he hits his mom, his mom gives him a cookie access.

And try to put it in one line because if you do multiple lines, then people are gonna put their comments in between yours, and then I won't be able to see what goes together.

So the antecedent, the behavior, consequence in the function.

Time to get ready for school, targets them aggressively gets to stay home.

Yep.

Right, I will wait.

Okay, told no to tablet, kicks and screams, gets tablet back.

Access to function.

Gives a command by parent, hits parent, does not complete the task or job.

Yeah, it's all pretty basic stuff.

Good.

Okay.

Teacher enters room, teacher asks to hang out clothes, student throws the outdoor clothes, teacher hangs up as clothes.

Okay, yeah, so very basic stuff, you guys get the concept.

Head bang, directed to room.

Yep, escape.

Okay, so then talk about what the, what you guys would do for offering for a break for your student in this context?

And be as detailed as you can for this particular student.

So versus like offer a break, think about where you could offer the break to.

Is the break gonna be like, they can go to their room for five minutes?

Is the break, they can walk around the block?

Is the break like what kind of break could you offer the student?

So Corey, is that a break or is that gonna be reinforcement?

Because that's fine if that's like a neutral, a neutral activity, but if it's like too fun, then it may end up increasing behaviors.

So you'll have to know your kid.

So like sometimes we'll let people read, but if a kid likes super loves to read, then we don't.

Five minutes before getting dressed, sit in a chair until he is ready to put his clothes away.

Yep, that's a good one.

So Corey, you know your student, but we do wanna make sure it's not too too fun.

Ask if she wants to start an hour in two minutes.

Yep, great.

Plush toys are soothing sensory base.

That's great.

All right, awesome.

So for always reinforced, think about some things that you'd wanna look for that you could reinforce.

So if you have a student who usually runs, but they're refusing the task, but staying present, then you could reinforce staying present.

Those like little behaviors outside of the big behaviors that you wanna look for to reinforce.

- [Shirley] And Saundra and Shelly, I'm just gonna break in and let folks know that I'm gonna put the BACB verification code in the chat for folks who are looking for it.

So I'll put it in there two or three times in the next couple minutes so that no one misses it.

- Calm body using words to protest instead of throwing things on the floor.

Yep, Megan, and then also be sure that if they use words to protest, then honor that protest, 'cause that's gonna be super important.

Yep, calm body, not head banging.

Yep, and this is the point too, right?

If they're trying to escape, right?

So there's the break, that's like, "Hey, go chill." But if they're like usually head bang and they're just sitting there and chilling and then they're like, "Yo, I don't wanna work." Let's honor that, 'cause that is a celebration.

I wanna have a party because he is not banging his head and he sat there and maybe he spit bit me, but then he said, "I'm done," but he did not slam his head into the table and I am thrilled.

Okay, safety.

What are the things for your student that you wanna really make sure you do safety wise, right?

Not every student do we need to clear the area of hard things.

The other thing too is be really careful, right?

Don't be like grabbing things all dramatically.

I worked in the school once, again, it was one of early in my career and we used to do a lot of physical management and I learned a lot there, but there are things that I feel differently about now, but they should have had a no jewelry rule.

Instead we were allowed to wear jewelry, but then if we had to do physical management on kids, everybody would take their earrings out.

And it wasn't I'm in a street fight, I'm gonna take my earrings out, right?

We weren't super dramatic about it, but we would casually take our earrings and our bracelets off.

But the kids were 7 to 10, and they knew what we were doing and they would escalate further.

And so you just need to be careful that even if you're making the environment safe, that you're not looking you're ready for a beat down or something.

So what specific things for safety you wanna make sure you have in place?

Learning keys in pockets, limit requests to areas with less hard objects.

We have a student that is sexually reactive.

So we just make sure there's only male staff, right?

So that's not a consequence intervention, but it's a preventive.

So I guess that's more of antecedent intervention, but we just make sure that when the student is escalating, that male staff is there and ensures that there's no any women, are not around.

So if they're out in the community or something that they have no women anywhere.

All right, I wonder state, what are some things you might say that you wonder?

Soft items nearby, yep.

And safety can also just be being ready for a hug, sometimes the babies need a hug.

I wonder statements.

Ooh, I wonder if he is nervous of high wins or didn't get enough sleep.

I wonder if you need help to hang up your clothes.

I wonder what would happen if you asked your teacher for help.

I wonder if you're not ready to put your clothes away yet.

I like it.

And so then Megan, you also have a really simple antecedent intervention here too, which is just like, have the teacher just put his coat away for him.

Right, so that just might be an easy solution.

While then you also work on a goal to teach him how to put his coat away at like a different time of day.

Because it just seems like every single day the teacher does it anyway.

So rather than avoiding, you can just avoid the tantrum is having the teacher do it, (Saundra laughs) even though that'll be annoying for the teacher, but the teacher is already doing it.

So that's probably what I would recommend.

I wonder if you're tired.

I wonder if you need help.

I wonder if you're hungry.

I wonder if you think this will take a long time.

I wonder if you're cold.

Yep, those are great.

Calm.

Remind him nan will always be there for him.

You know, Laura, have you guys tried giving him a picture?

How old is he?

10, what about a little stuffy with her face on it.

Personal space is a good one.

All right, and then silliness And Laura, another thing that can work is like a, oh, I see, another thing is like a rules card.

The thing is, is if it's a grandma then they are old and could pass, and so that's a struggle.

But like a rules card kind of thing versus just like a I'm gonna tell you this, but a little social story.

I go to school, this is my schedule.

When I get home, grandma picks me up or you know what it is.

I don't know if you've tried that yet, but those work sometimes.

And then he can just like, look at it throughout the day, and if he can't read like a little picture thing that can just be reviewed every morning and every night or whatever throughout the day, and those things can be really successful because then it like, it's not my rules.

It's on the paper, so it's on the paper, so it must be true.

So yeah, but you do have to be careful not to promise that she will always be around because she will not.

Okay, so silliness.

Sing and dance.

All right, and then what did your kids get as a result of, if you all know people's trauma histories, what did they get as a result of their behavior in the past on the trauma side of things?

He knows where his caretaker is, yep.

Yep, restraint may have been used in the past.

We don't think about enough about educational trauma or school trauma.

I mean, even just like, I get so many students who you can just tell by the school reports that the teacher just doesn't like them.

And so even if they didn't get held down, just having an adult not like you has its own effects.

Great, and then just write down, what the effects of the traditional interventions would be versus the trauma-informed interventions.

And so after we do that then I want at least one answer in the chat and then I will be a happy duck.

I'm hoping somebody is typing the bestest answer in the whole wide world and thinking diligently about it because I know y'all are amazing and focused and wanna get your BCBA and CEU credits.

And so, oh, there we go.

The traditional would be probably wait 'em out, maybe planned ignore.

And the trauma inform sets him up for more success and respect and dignity in front of his peers.

You know what?

That is a super good point, Megan, is that one of the things we don't think about a lot is how these interventions, that they're not all done at homes, right?

When they're done in schools, our peers see everything.

And so sometimes we clear out classes when somebody's acting up, and that is a huge impact on the education of the other students.

And also all the other students know who the bad kid is, right?

If you ask any kid, who's the bad kid in your class?

They're all gonna say, it's the kid, and they're gonna be able to label the kid, who's having the difficult behaviors.

And we make that worse when we try to do these extinction verses.

It's more isolating for the traditional and the trauma informed feeling cared for, reassured, and learning skills.

I actually was listening to a podcast that was talking about consulting in schools.

And they talked about how they don't trigger kids' behaviors in schools, just for this reason when they do FBAs, that they were like, you know, that's nonsense, I can just ask the teacher what happened.

(Saundra laughs) And they were like, yeah, technically I'm supposed to see the behavior, but like why am I gonna get a kid riled up in their classroom and disrupt the educational environment of 32 kids when really the teacher's gonna give me an accurate explanation of it.

And then I can observe the classroom and fill in the rest.

And I think that that's where our science needs to have that flexibility sometimes to consider the dignity of our sense.

Cool.

All right, so this is my trauma manual.

It's super awesome and cool.

And we also have a mini book, which is on the website too, which is only a dollar and it's very exciting, and it's like a precursor to this.

It actually is what goes along with this webinar, it's with the mini book or it's with the consequence interventions.

So that's available, I'm super excited.

And then this is a super cute little video on a strategy that we can use with kids on a calming strategy that I think is super adorable.

Now I'm gonna play it for you.

And then I'll answer questions after.

(bright music) You can hear it, yeah?

- Breathe.

(bright music)

♪ Sometimes the monster that's inside you ♪

♪ Is a monster that is mad ♪

♪ It's a monster who is angry ♪

♪ It's a monster who feels bad ♪

♪ When your monster wants to throw things ♪

♪ And your monster wants to shout ♪

♪ There's a way to calm your monster ♪

♪ And chill your inner monster out. ♪ 

♪ Belly breathe gonna breathe right through it ♪

♪ Belly breathe this is how you do it ♪

♪ Belly breathe gonna breathe right through it ♪

♪ Belly breathe this is how you do it ♪

♪ Put your hands on your tummy now you're ready to begin ♪

♪ Put your hands on your belly ♪

♪ And you slowly breathe in ♪

♪ Ba ba breathe, belly belly ♪

♪ Ba ba ba ba breathe, belly belly breathe ♪

♪ Feel your belly go out and in and in and out ♪

♪ And you start to calm down without a doubt ♪

♪ Feel your belly go in and out and out and in ♪

♪ Now Elmo feels like himself again. ♪

♪ Belly breathe gonna breathe right through it ♪

♪ Belly breathe this is how you do it. ♪

♪ Ba ba breathe belly belly ♪

♪ Ba ba ba ba breathe belly belly breathe ♪

♪ Your mad monster may appear at any time and any place ♪

♪ And that mad monster will make ♪

♪ You make a mad monster face ♪

♪ He makes you wanna push ♪

♪ He makes you wanna shove ♪

♪ There's a way to calm that monster ♪

♪ Bring out the monster love ♪

♪ Belly breathe gonna breathe right through it ♪

♪ Belly breathe this is how you do it ♪

♪ Belly breathe gonna breathe right through it ♪

♪ Belly breathe this is how you do it ♪

♪ Your belly go out and in and in and out ♪

♪ That's what belly breathing is all about ♪

♪ Feel your belly go in and out and out and in ♪

♪ And now I feel like myself again ♪

♪ Belly breathe gonna breathe right through it ♪

♪ Belly breathe this is how you do it ♪

♪ Belly belly breathe belly belly breathe ♪

♪ Everybody breathe, breathe ♪

♪ We work out funny little monster ♪

- Anyway, Elmo was super cute.

(bright music)

Ah! Okay, so yeah, so if people have questions, we have five more minutes.

- Well, just as we're giving folks a little time to type in any questions that they may have, I just wanna pop in and say, thank you so much for the information, for sharing your expertise with us, and for spending these three afternoons with us.

I know that I've heard from lots of folks who've found the information just so valuable and it resonates so well with, you know, kind of their underlying values and their approach to professional practice.

So just wanna say thank you for helping us put all of these pieces together, and it's certainly been a pleasure to have you with us for these three sessions.