Least Restrictive Behavioral Interventions: A need for guidelines on the use of aversives, restraint

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Least Restrictive Behavioral Interventions A
need for guidelines on the use of aversives,
restraint and seclusion in Louisiana Schools

• Ken Denny
• Louisiana State University

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What are aversive interventions?

• Aversives include any stimuli / environmental
  event intended to be unpleasant, cause physical
  pain, or humiliate.
• Many things can be aversive to an individual and
  it is probably impossible to eliminate all of
  them from a persons life!
• It is possible and advisable to limit the use of
  aversives

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Some aversives have long histories
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Aversives

• Nationwide, federal data indicate that 41,972
  special education students received corporal
  punishment in the 2006-2007 school year.
• Special education students receive corporal
  punishment at disproportionately high rates. For
  instance, in Texas, the number of special
  education students who were paddled in the
  2006-2007 school year amounted to 18.4 percent of
  the total number of students who received
  corporal punishment statewide.

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Restraint

• Restraints involve the forced restriction or
  immobilization of a childs body or parts of the
  body to achieve a designated behavior using
  physical, mechanical or chemical means, or
  seclusion.
• Physical restraints involve the use of physical
  force by one or more individuals that reduces or
  restricts an individuals freedom of movement,
  often involving various holds designed to
  immobilize a person or bring them to the floor.
• Mechanical restraints include straps, cuffs,
  body/blanket wraps, helmets and other devices to
  prevent movement and or sensory perception, often
  by pinning a childs limbs to a splint, wall,
  bed, chair or floor.

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Teaching Tools??
Rifton chairs are not intended for behavioral
purposes
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Seclusion

• Seclusion, also considered a form of restraint,
  involves involuntary confinement in a room, box,
  structure or space from which the individual
  cannot escape.
• Seclusion does not include allowing an individual
  to take a break from an activity, to move to a
  quieter or less stimulating location or to enjoy
  privacy.

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Emergency

• In emergencies, school personnel are permitted to
  act to control a students behavior posing a
  clear and present danger of serious physical harm
  to the student or others, and which cannot be
  immediately prevented by a less restrictive
  response.

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Common myths about aversives, punishment,
seclusion and restraint
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Myth Aversives, restraint, seclusion are
effective treatments

• Fact
• Our professional literature, research, and
  clinical experience would support that they
  represent the FAILURE of intervention and
  treatment

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Myth Punishment procedures are more powerful
than reinforcement based procedures

• Fact Powerful punishers may decrease problem
  behavior rapidly (its a fact)
• BUT
• punishment does not teach appropriate behavior
• can serve as an inappropriate model
• can make the punisher punishing!
• has problems with maintaining and generalizing

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Myth Punishment will keep people safe

• Fact procedures are misused and abused children
  are being hurt and are dying
• 142 deaths found from 1988 to 1998, reported by
  the Hartford Courant
• 50 to 150 deaths occur nationally each year due
  to seclusion and restraints estimated by the
  Harvard Center for Risk Analysis (NAMI, 2003)
• A growing list of additional children on the on
  the Restraint DEATH List maintained by the
  COALITION AGAINST INSTITUTIONALIZED CHILD ABUSE

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Myth If everything we (schools) have tried has
failed that is sufficient to use punishment or
restrictive procedures

• Fact Decades of research have proven safe,
  positive methods of changing and re-directed
  behavior to be successful regardless of a childs
  diagnostic label, degree of disability, or
  severity of problematic behaviors.
• School personnel need to be trained in and use
  research-validated methods for promoting positive
  behavior change and crisis de-escalation.

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• Just because it might work doesnt mean you
  should do it!

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• There are interventions / treatments that should
  be rejected
• Because they dehumanize and stigmatize the
  individual
• Because they violate community/ family /
  individual acceptance
• Because they inflict intentional emotional or
  physical pain
• Because they do not leave the individual better
  off , more independent, and/or happier

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9 Year Old Arrested at School (WINK News
10/15/08)
A 9-year-old girl was arrested at Royal Palm
School on Tuesday and is now facing two felony
charges for battery on an education employee. The
report says the girl purposely spit on her two
teachers while they tried to control her.
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State of the States

• forty-one percent (41) have no laws, policies,
  or guidelines concerning restraint or seclusion
  use in schools
• almost ninety percent (90)still allow prone
  restraints,
• only forty-five percent (45) require or
  recommend that schools automatically notify
  parents or guardians of restraint/seclusion use
• (National Disability Rights Network, 2009)

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Ryan, Peterson, and Rowalski (2008)

• Fifty percent (12 of the 24) policies which were
  identified required school systems to develop
  written procedures for the use of seclusion
• 16 (67) established requirements for rooms used
  for seclusion. A smaller number banned the use of
  locked timeout rooms.
• Fifteen (62) required parental notification of
  the use of seclusion timeout, and an even larger
  number (21 or 87) required documentation of each
  timeout event.
• Fifteen (62) also recommended or required staff
  training if seclusion timeout was to be employed.
  

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Ryan, Peterson, and Rowalski (2008)

• Fifteen of these state policies also addressed
  the length of time students would be in timeout.
• Four (17) specified 12-15 minutes maximum (at
  least for elementary aged students)
• six (25) required a 20-30 minute maximum or that
  students must at least be reassessed after that
  period of time. Four more specified 55-60
  minutes as the limit.

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A call for action

• Because there is no monitoring on a national
  level, the full extent of death, injuries, and
  harm from the use of these techniques is unknown.
  
• Although some states have standards and
  regulations regarding restraints, seclusion and
  aversive interventions, the existing laws are not
  uniform and may not be enforced. Other states
  provide little or no protection for children at
  all.
• Districts could restrict procedures (several do)
  through local policies and procedures . Key is
  not to wait for a situation to occur

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Louisiana

• Currently Louisiana provides no policy or
  guidelines for schools in
• Seclusion
• Restraint
• Aversive Interventions with students with
  disabilities

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Principles that Guide the Selection for Behavior
Reduction

• Principle of least intrusive alternative
• Select the intervention that is least intrusive
  and still effective
• Selected intervention should be based on the
  identified function of the challenging behavior

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Hierarchy of Procedural Alternatives for Behavior
Reduction
Level I Strategies of differential
reinforcement A. Differential Reinforcement of
Low Rates of Behavior (DRL) B. Differential
Reinforcement of Other Behavior(s) (DRO) C.
Differential Reinforcement of Incompatible
Behavior (DRI) D. Differential Reinforcement of
Alternative Behavior(s) (DRA) E. Noncontingent
Reinforcement
Level II Extinction (terminating reinforcement)
Level III Removal of desirable stimuli A.
Response-cost procedures B. Time-out procedures
Level IV Presentation of aversive stimuli A.
Unconditioned aversive stimuli B. Conditioned
aversive stimuli C. Overcorrection procedures
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Need to establish hierarchy of intervention
procedures
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Principles for Developing Legally Correct
Seclusion Timeout or Physical Restraint Policies
(Rozalski et al., 2006 Ryan, Peterson Rowalski
2007)

• 1. State Education Agencies should require
  public school districts to develop policies and
  procedures regarding the use of aversives,
  seclusion timeout, and physical restraint with
  all students.
• 2. Aversive procedures, seclusion timeout and
  physical restraint procedures should be included
  in a student's IEP or Section 504 plan.
• 3. Seclusion timeout and physical restraint
  should be used only when a student's behavior
  poses a risk of injury to the student, to peers
  or staff members.
• 4. Aversive procedures, seclusion timeout and
  physical restraint should be used only after less
  restrictive interventions have documented to not
  have been successful.
• 5. State education agencies, teacher training
  institutions, and public school districts should
  develop appropriate pre-service and in-service
  training experiences so that staff members who
  may be required to use seclusion timeout and
  physical restraint receive thorough and
  continuous training in the appropriate use of the
  procedure.

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Guidelines Continued

• 6. Teachers should continuously collect
  meaningful data to document the efficacy of
  seclusion timeout and physical restraint.
• 7. Teacher should keep thorough records when
  seclusion timeout or restraint are used.
• 8. Administrators should develop methods to
  periodically review and summarize teacher and
  school-level data on the use of seclusion timeout
  and physical restraint.
• 9. State education agencies should collect data
  on the frequency of use of seclusion timeout and
  physical restraints in the public schools.
• 10. State education agencies should explore
  system-wide alternatives to seclusion timeout and
  physical restraint and develop appropriate
  teacher and administer training.
• Modified from Rowalski, et al., 2006

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Questions ??

• http//www.lapositivebehavior.com
• rdenny_at_lsu.edu