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

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Aversives include any stimuli / environmental event intended to be unpleasant, ... Because they inflict intentional emotional or physical pain ... – PowerPoint PPT presentation

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


1
Least Restrictive Behavioral Interventions A
need for guidelines on the use of aversives,
restraint and seclusion in Louisiana Schools
  • Ken Denny
  • Louisiana State University

2
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

3
Some aversives have long histories
4
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.

5
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.

6
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7
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8
Teaching Tools??
Rifton chairs are not intended for behavioral
purposes
9
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.

10
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11
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.

12
Common myths about aversives, punishment,
seclusion and restraint
13
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

14
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

15
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

16
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.

17
  • Just because it might work doesnt mean you
    should do it!

18
  • 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

19
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.
20
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)

21
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.

22
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.

23
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

24
Louisiana
  • Currently Louisiana provides no policy or
    guidelines for schools in
  • Seclusion
  • Restraint
  • Aversive Interventions with students with
    disabilities

25
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

26
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
27
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28
Need to establish hierarchy of intervention
procedures
29
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.

30
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

31
Questions ??
  • http//www.lapositivebehavior.com
  • rdenny_at_lsu.edu
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