In the Name of Treatment A Parent's Guide to Protecting Your Child From the Use of Restraint, Aversive Interventions, and Seclusion

[Guest guest]

in the Name of

Treatment

A Parent's Guide to Protecting Your Child

From the Use of Restraint, Aversive

Interventions, and Seclusion

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TASH

www.tash.org

National Disability Rights Network

www.ndrn.org

Family Alliance

to Stop Abuse and Neglect

www.thefamilyalliance.net

Bazelon

Center for Mental Health Law

www.bazelon.org

Federation of Families For Children's Mental Health

www.ffcmh.org

National Down Syndrome Congress

www.ndsc.org

National Association of Councils on Developmental Disabilities

www.nacdd.org

National Down Syndrome Society

www.ndss.org

Autism National Committee

www.autcom.org

The Arc of the United States

www.thearc.org

The RespectABILITY

Law Center

VISION

All children with disabilities should grow up free

from the use of restraint, seclusion, and aversive

interventions to respond to or control their

behavior, and from the fear that these forms of

behavior management will be used on

themselves, their siblings or their friends.

www.aprais.org

This publication was developed by APRAIS, with

editorial assistance

and funding support from the founding organizations. Photographs

have

been contributed

by the families of children who have been harmed by the

use of restraint, aversive interventions, and seclusion, and are

used with

their permission.

This publication is dedicated to the memory of

Goodman (1987-2002) and to all those children who continue to be

abused and to die " in the name of treatment. "

In the Name of Treatment: A Parent's Guide to Protecting Your Child

from Restraint, Aversive Interventions, and Seclusion is available

on

the APRAIS

web site, www.aprais.org

You may download a hard copy off the

website. Print copies of this guide may be obtained from TASH by

sending

check or credit

card authorization for $5.00 per copy (includes postage) to:

TASH, 29 W.

Susquehanna Ave, Suite 210, Baltimore, MD 21204 (Please call

TASH for information on bulk discounts).

For resources on Positive Behavior Support or more information

about national

efforts to promote safe, respectful, and effective

behavior and

education services and supports for children and

youth with disabilities contact:

Federation of Families for Children's Mental Health

1101 King Street, Suite 420, andria, VA 22314

Office: (703) 684-7710 Fax: (703) 836-1040

http://www.ffcmh.org

TASH

29 W. Susquehanna Ave., Suite 210

Baltimore, MD 21204

Office: (410) 828-8274 Fax: (410) 828-6706

http://www.tash.org

© 2005 The Alliance to Prevent Restraint, Aversive Interventions,

and Seclusion

(APRAIS). Reproduction of this publication all or in part is

authorized for noncommercial

advocacy or educational purposes with full attribution to APRAIS.

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Every day in this country, children with disabilities are needlessly being subjected to

harmful practices in the name of treating " challenging behaviors. " They

are

brought down to the ground and straddled,

strapped or tied in chairs

and beds, blindfolded, slapped

and pinched, startled by cold water sprays in the face,

deprived of food, secluded in locked

rooms, and more, despite the

fact that research and practice show that these techniques exacerbate

challenging behavior

and do nothing to teach the child appropriate behaviors. This

guide, a joint effort of the founding organizations of APRAIS, is

written in response to this

alarming problem.

Across the country, teachers, aides, and program staff who have been entrusted with children's care,

protection, education, and development are subjecting them to this

" treatment. "

In fact, such negative and dangerous activities are often inappropriately

included as part of these children's education plans in the hope that

they will reduce

the occurrence of unwanted behavior. Children learn nothing about

acceptable behavior from the experience of being hurt, secluded, or

immobilized by their

caregivers. Children with serious communication, social, and behavior challenges need

effective, research-based, positive approaches based on Positive Behavior

Supports (PBS). PBS teaches desired behaviors, useful skills, and

fosters healthy emotional development and interactions with others. PBS

is widely accepted as effective evidence-based practice that not only

reduces even the most dangerous and disruptive behaviors, but focuses on

the vision of quality of life.

Many parents are unaware that their children are being routinely

hurt, restrained, secluded, and subjected to painful and ineffective practices by

their school or program. Some have signed vague or confusing consent forms which offered no clear

picture of the dangerous interventions planned for their child. Other

parents are aware of and deeply troubled by the methods used on their

child, but have

been threatened with loss of the placement or other essential services if

they object.

Every year, children with disabilities are injured, traumatized, and even die as a

result of inappropriate and inhumane interventions.

The deliberate use of pain, humiliation, exclusion, and

immobilization on a child has all the hallmarks of abuse. Most parents assume

that a child with disabilities has the same protections against abuse

that other children are given. Unfortunately, the programmatic

application of these abusive procedures on children with disabilities

is often treated differently. In many special education programs

and service delivery systems the use of pain and humiliation (aversive

interventions) and immobilization (restraint and seclusion) to control or

change behavior is state-sanctioned - allowed under a confusing patchwork

of outdated, poorly-written, or overly permissive laws and

regulations. When abuse is permitted in this way, parents may find that the usual responses to

child endangerment, such as seeking help from school administrators,

the police, or the courts, fail to solve the problem.

Goodman, age 14, died in February of 2002 after 16 months of physical and

chemical restraint

> ~ 4 ~

AVERSIVE INTERVENTIONS

(or " aversives " ) involve the deliberate infliction of physical

and/or emotional pain and suffering, for the purpose of changing or controlling

a child's

behavior. Aversives include (but are not limited to) techniques such as

direct physical or corporal punishment (hitting or pinching);

visual screening; forcing a child to inhale or ingest noxious

substances; sensory deprivation; depriving a child of food, use of a

toilet, or other health-sustaining necessities; and temporarily but

significantly depriving a child of the ability to move. Use of restraint devices as well

as blindfolds, visual screens, and white noise helmets results in

sensory deprivation.

Techniques that deliberately disrupt a child's basic emotional

well-being and sense of safety, or that result in the long-term loss of

the normal

freedoms and pleasures of childhood by preventing exercise, peer

interactions or other activities may also be considered aversive.

RESTRAINT is a type of aversive that involves the forced

restriction or immobilization of the child's

body or parts of the body, contingent on a

designated behavior. There are three types of restraint. Manual restraint

involves various " holds "

for grabbing and immobilizing a child or bringing a child to the floor. The

child is kept in the chosen restraint position by one or more staff person's arms, legs,

or body weight. Mechanical restraint is the use of straps, cuffs, mat

and blanket wraps, helmets, and other devices to prevent movement and/or sense

perception, often

by pinning the child's limbs to a splint,

wall, bed, chair, or floor. Chemical restraint means using

medication to stop behavior by dulling a child's ability to move and/or

think. Medication specifically prescribed to treat symptoms of a

disability or illness is not a chemical restraint.

It is generally accepted that brief physical intervention used to

interrupt an immediate and serious danger to the child or others may

be called for in the case of safety emergency. This is different

from the ongoing use of restraint as punishment or in the guise of

treatment for a child's disability or behavior. Frequent use of

emergency restraint is an indication program revision is needed,

even if the program is considered positive.

SECLUSION involves forced isolation in a room or space from which

the child cannot escape. Allowing a child to voluntarily take a

break from activities is not considered seclusion.

Definitions immediate threat their child is facing.

When abuse is sanctioned, it becomes less visible. Injuries and

deaths involving

these procedures are believed to be significantly

underreported. The kinds of investigations that would expose the

nature and extent of the problem are seldom done, and

accurate information

based on medical or forensic reporting is difficult to obtain. The

deaths and injuries of children with disabilities are too easily

blamed on accidents or on aspects of the disability itself. But in recent

years parents are speaking out, and advocacy organizations, legislators,

and the courts are realizing the seriousness of this threat to the

basic human rights of vulnerable children and youth. Aversive interventions,

restraint, and seclusion are used on children across the spectrum of

disabilities,

including those with autism, learning disabilities, mental health

needs, cognitive challenges, and children with physical and sensory

disabilities. Schools and

programs continue to use aversive interventions, restraint, and

seclusion for a variety of unacceptable reasons, for example: because

they are understaffed;

for staff convenience; because they think " bad behavior "

should be punished; because they do not believe the children they serve

have the same needs,

rights, and feelings as children who do not have disability labels;

or because the school or program lacks leadership and does not empower

teachers and

staff with the knowledge, support, and positive alternatives they

need. The use of aversives, restraint and seclusion has resulted in

hundreds of deaths and thousands of injuries.

Even when no physical harm is apparent, these techniques cause

psychological trauma and rob people of their dignity.

The purpose of this publication is to help parents and families

learn more about the dangers of the use of aversive interventions, restraint,

and seclusion,

and to assist them in keeping children safe while dealing in a positive

way with challenging or inappropriate behaviors.

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What are the dangers and risks to children? Positive behavior

nterventions are safe in the short run, and in the long run promote

habits and attitudes that continue to reduce risk. On the other hand,

aversive interventions, restraint, and seclusion may cause injury

and death,and they can backfire in ways that cannot be predicted

or controlled. According to the professional literature, the

following are some crucial considerations in choosing safe,

respectful, and effective interventions:

Children generalize what they learn. Anxiety and avoidance

triggered by aversives, restraint, and seclusion will spread to

other areas of a child's life and become an obstacle to achieving

desirable behaviors, attitudes, and progress. For example, a child who

experiences aversive procedures in the classroom will come to fear

and avoid the classroom itself, the teacher, the school bus, the school,

and the learning process in general.

Children learn from their experiences with adults. Physically

coercive activities teach children that " might makes right " and that

physical means of

problem-solving are acceptable. The small child who is easily

restrained today will soon become a large, strong teenager able to

demonstrate the

dangerous behavior he/she has been taught. We can help a child best

by seeking the underlying cause of his or her behavior. When

aversive techniques, restraint, and seclusion are used to stop behavior

for the short term, the real cause of that behavior goes undetected and

unresolved. The underlying cause, whether medical, emotional, or

social, is masked by these methods and can worsen as a result of the very

techniques used. Adults can teach children alternate ways to

communicate. Helping children learn new skills provides them with

opportunities for achieving success. Aversive strategies, restraint, and

seclusion

do not offer the child useful alternative behaviors. For instance,

a child who is squirted in the face each time he or she screams is not

learning new and better

ways to communicate with teachers and staff or to solve the problem

that is causing the screams. Positive strategies can flourish

only when negative interventions are rejected. The use of restraint,

seclusion, and restrictive techniques take time, training, and

imaginative energy away from the search for positive strategies for

children with disabilities. Teachers or staff may be caught in a cycle of

negative responses from which it becomes increasingly difficult to

escape.

Trusting relationships between a child and his or her teacher,

combined with a sense of safety, are fundamental for healthy child

development. Aversives, restraint, and seclusion eliminate the opportunity

for such an environment or relationship.

Children need to know that their bodies are their own, and that

sometimes it is right to refuse or say " no. " When children are

taught that it is

appropriate for adults to grab and hold them, and that a

" good " child should submit without objection, these children

can become easy victims for sexual

predators.

All children should enjoy equal protection from danger and risk.

Children with disabilities are already three times more likely to be abused

than

children without disabilities. Permitting dangerous activities

labeled as treatment leaves this vulnerable group with unequal protection

under the law.

When children with disabilities are taught alongside their typical

peers, positive strategies are more likely to be the norm. Schools and

programs

that use aversives, restraint, and seclusion tend to operate in

segregated settings, away from public view, because these dangerous

interventions violate

community standards and values.

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There are several important steps you can take to help ensure the

safety of your child:

• know your rights

• learn all you can about

positive behavior supports

• evaluate your child's program

• be aware of the warning signs of abuse

• act promptly when you see a problem

• join with advocates nationwide to demand an end to the use

of aversive procedures, inappropriate restraint, and seclusion

The following pages provide in-depth information on each of these

steps. Considerations in choosing effective treatment

Trauma and Child Development

Practitioners of aversive techniques, restraint and seclusion

used to believe that if the

child was not physically injured by such interventions, they had

done a safe job. Now we know better. Advances in our understanding

of child

development emphasize the importance of a secure, well-balanced

emotional life. A child repeatedly subjected to these techniques

grows up feeling helpless, frightened, frustrated, or angry. The

child's reactions may become increasingly stressed. Over time, the

overworked stress response system of the child's brain can become

unbalanced, creating an ongoing state of high arousal. Repetitive,

impulsive activity patterns, such as the " fight or flight "

response, become

locked in as the child's brain chemistry changes. The child becomes less

able to control emotions, to pay attention, or to take in new information

and use it to make appropriate decisions. Eventually, such a child

may misinterpret even the well-intended actions of others as threatening.

These classic responses to trauma interrupt and can permanently

alter brain development. They fuel a downward spiral in which teachers

or program staff are both creating and responding to the child's

anger and inflexibility.

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Know your rights

There are no justifiable reasons for using aversive interventions,

restraint, and seclusion. Laws and regulations covering most children's

service delivery

systems generally agree that aversive interventions, restraint, and

seclusion may not be used for purposes of staff convenience, or as

coercion, punishment, or

retaliation. These methods are not " teaching " methods

because they do not teach positive behaviors. The use of aversive interventions,

restraint and

seclusion under the guise of therapeutic or educational

interventions is unethical because these procedures create risk

and unnecessarily take away basic rights.

There is a lack of evidence that aversive techniques

offer a safe means of teaching desirable, self-directed

behavior that a child can maintain over the long term. Safe,

positive methods of changing and redirecting behavior are well documented

Evidence shows them to be successful regardless of the child's

diagnostic label, degree of disability, or severity of behaviors. The

responsibility to employ best

practices, and the obligation to do no harm in treatment require

that the least dangerous, least intrusive,

and least restrictive methods always be used.

Individual liberty is protected under the doctrine of least

restrictive alternative (LRA). LRA requires careful consideration of the

individual's interests; the

purpose of treatment; and, the interventions and environments

chosen to provide treatment. Additionally, interventions must be demonstrated

as

effective for the purpose for which they are used, and there must

be proof of therapeutic justification. LRA, therefore, provides parents

and advocates a strong

constitutionally based argument in favor of positive interventions

over the use of aversive interventions, restraint, and seclusion - all

highly restrictive

procedures. The IDEA supports positive approaches for all students.

The Individuals with Disabilities Education Act (IDEA) creates a

presumption in favor of positive methods, requiring an IEP team to

consider using positive behavior interventions and strategies when addressing

a child's behavioral concerns. A Functional Behavioral Assessment is the

type of evaluation used to determine a child's behavior support

needs. From this evaluation, a behavior What About Emergencies?

Aversive interventions and seclusion are not

appropriate even in a safety emergency. However,

brief physical intervention may occasionally be

needed to prevent a child or those around him/her

from immediate physical danger. Every parent

respects the need to stop a child from darting into

traffic or stop a child from a self injurious incident.

It is also commonly understood that no child

should endlessly repeat these experiences. Instead

we must teach appropriate behavior and make

indicated environmental changes. We must learn

from emergencies so that they become extremely

rare.

Some programs assure parents that they don't use

restraint as treatment, yet their rate of emergency

restraint is high. In these cases, it is likely that

restraint " treatments " have simply been re-named

restraint " emergencies. " Observe what your

child's program is calling an " emergency: " Is it a

situation that staff escalated? Is it a situation that

teachers or staff could have avoided by

collaborating with you and your child to solve the

problem at hand, or defused by using de-escalation

techniques? Is risk to property used as an excuse

for restraint? Are children being restrained when

the risk of physical injury is relatively minor (e.g.,

a child is picking at his skin or banging on her

desk)? Are children restrained on the grounds that

their present activity might lead to danger at some

future time? If any of these answers is yes, that

situation is not a safety emergency, and restraint

should not be employed.

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intervention plan may be developed. Completing a

Functional Behavioral Assessment means observing a

child's behavior through a variety of methods and

asking questions such as: What does the child achieve

through the use of this inappropriate behavior? Why

and when is it happening? How can we teach the child

more desirable skills and behaviors that will allow him

or her to achieve the same results in a more socially

acceptable way? The concept of a Functional

Behavioral Assessment has been highly developed in

research and practice, and should lead to positive

behavioral interventions and supports.

Emphasis on the development of new, positive skills is

different from the use of aversive techniques, restraint

or seclusion, which are applied solely to control or

reduce unwanted behaviors.

Some states have clarified the language in IDEA even

further, specifying in state law or regulations that all

methods used to support children with disabilities in

the schools must be positive. Check with your state

Protection and Advocacy organization, Department of

Education, or public interest education law office to

learn what additional protections your state may offer.

The use of aversive techniques, restraint, and

seclusion can lead to violations of the " free and

appropriate public education " (FAPE) provision of

IDEA. Under IDEA, an appropriate special education

program must be designed to provide the student with

meaningful educational benefit. However, students do

not learn meaningful lessons about alternative ways of

communicating and interacting when teachers and

program staff respond to their challenging behaviors

with aversive interventions, restraint, or seclusion.

Often the frustration and anxiety caused by these

negative procedures cause the child's original

behavior to worsen, or to be replaced by other equally

undesirable activities. When children suffer a high

degree of anxiety and stress, their ability to process,

retain, and act on new information is severely

compromised, further undermining their ability to

access FAPE.

The implementation of aversive techniques, restraint,

and seclusion takes time and attention away from the

child's IEP goals, so that educational progress is

hampered. The use of these techniques, or even a

request from the child's program for permission to use

them, should immediately suggest that the student's

programming is not effective. Parents can exercise

their right to a new IEP meeting, at which all aspects

of the student's IEP and behavior support plan should

be reevaluated.

The Children's Health Act of 2000 protects children

in certain settings. The Children's Health Act of 2000

sets a federal floor of protections covering children in

" psychiatric residential treatment facilities " (PRTFs)

under the Medicaid program, as well as those in

" certain non-medical community-based facilities for

children and youth. " In these settings, restraint and

seclusion may be used only to ensure the physical

safety of the resident or others and may only be

ordered by a physician or other professional licensed

to order restraint and seclusion. Federal regulations

from the Centers for Medicare and Medicaid Services

(CMS) have further strengthened these protections for

residents of PRTFs, requiring that a physician or

licensed independent practitioner make a face-to-face

physiological and psychological assessment of the

Does My Child Have

Constitutional Protections?

The use of aversives, non-emergency restraint,

and seclusion in facilities run by federal, state or

local governments raises important issues of

constitutional protections. Some courts have

ruled against the use of these behavioral

interventions on people with disabilities on the

grounds that they violate the Eighth Amendment

prohibition against " cruel and unusual

punishment. " Other legal decisions have found

the Eighth Amendment to apply only to prisons

and other penal facilities. This leads to a

seemingly indefensible predicament: certain

aversives and restraints permitted for

" therapeutic " use on children with disabilities are

considered too inhumane to be constitutionally

applied as punishments in prisons.

Unjustified restraint use in public facilities has

been successfully challenged as a violation of

constitutionally protected liberty interests under

the Fourteenth Amendment. The Supreme Court

(in Youngberg v. Romeo, 1982) found that a man

with mental retardation who was committed to a

state facility had constitutional rights, including a

right to reasonably safe conditions of

confinement, freedom from unreasonable bodily

restraints, and minimally adequate training. The

Supreme Court thus adopted the position that

persons involuntarily committed " retain liberty

interests in freedom of movement and in personal

security " and that providers risk liability when

they use aversives or restraints.

~ 9 ~

child within one hour of the start of emergency

restraint or seclusion. This statute and regulations

represent a significant advance in no longer approving

the use of restraint and seclusion as ongoing

" interventions " for children. However, many

residential facilities for children still are not covered

by these rules.

Parents and others concerned about the inappropriate

use of these interventions and other issues involving

inadequate treatment or unsafe conditions in health

care facilities may file a complaint with the regional

CMS office or the facility's licensing agency in the

state. CMS or the state will conduct an investigation

and, if violations of Federal or State standards are

found, will require the facility to implement corrective

measures. Contact information for CMS regional

offices may be found on CMS's website at http://

www.cms.hhs.gov/about/regions; contact information

for state licensing agencies may be found at http://

www.cms.hhs.gov/clia/ssa-map.asp.

You have the right to be fully informed and to deny

consent. Because of the dangers involved in using

aversive techniques, restraint, and seclusion,

programs wishing to use them must require children's

parents or guardians to give " informed consent. " You

have the right to refuse that consent. You may even

wish to preemptively deny permission for your child's

school or program to use these methods on him or her

by using the model " No Consent Form " on page 15 of

this publication. Remember that a special education

program developed without parental input is in

violation of the procedural requirements of IDEA.

Parents should beware of " stealth consent forms "

that some programs try to slip under their radar when

their child is admitted. These consent forms are

vaguely worded, asking only for the parent or

guardian's permission to use " restrictive procedures "

(or some other unclear term). Parents may have no

idea that " restrictive procedures " means more than

latches on the windows or seat belts on the bus, but

refers to aversive techniques, restraint, and seclusion.

Although called " informed consent, " the consent

process seldom meets this standard because schools

often fail to provide parents with all necessary

information about physical and psychological risks to

their child, and about positive alternatives. The

> request for consent may be questioned or challenged

on this basis.

Parents have reported facing " coerced consent " when

programs threaten to stop serving their child unless

consent for aversives, restraint, or seclusion is given.

It is important to seek a knowledgeable advocate or

legal assistance if such threats are made. Your child

maintains certain legal rights to continuity of

placement and other services under the IEP, and often

under other service contracts and regulations as well.

You have the right to fully informed and

appropriately trained teachers and staff. These are

some important questions to ask: Have staff been

fully trained in positive means of support? Have they

been trained in techniques of prevention, deescalation,

and redirection in the face of a challenging

situation? Have they conducted a functional

behavioral assessment? If restraint is being used, how

were staff trained, are adequate numbers of trained

staff always on duty, and is medical oversight

adequate and readily available? Have staff tried all

proposed interventions on themselves first? Do staff

fully understand the laws, regulations, and ethics that

govern their actions? Are staff fully aware of the

physical and psychological risks to your child, and of

the legal risks to themselves, if they resort to the use of

aversive techniques, restraint, or seclusion?

Programs and their staff face legal liability (and

unwelcome publicity) when they make poor choices of

interventions. Assuring that they are informed of

these possible consequences often has a positive effect

on staff behavior.

Parental Discipline:

Not a problem

Aversive Programs:

Not a solution

Protecting children from the programmatic use

of aversive techniques, restraint, and seclusion

has no effect on parents' right to discipline their

offspring, to say " no, " or to respond to

emergencies. To reject these methods is to

limit professionals' rights to design and

implement an ongoing program based on pain,

humiliation, or immobilization.

Such a program cannot be equated with

everyday family discipline, such as saying " no "

to a child's unreasonable request. It also cannot

be equated with one-time reactions to behavior

in the face of emergencies (e.g. grabbing a child

to get him/her out of the path of a vehicle),

since that is not a behavior program.

~ 10 ~

Behavior that challenges us is a symptom of a

problem, not the problem itself. It tells us to

look closer and listen harder, because

something is wrong. Behavior problems are messages

about what is happening in someone's life. By joining

in the communication, rather than shutting it down,

we can identify the problem and find positive

solutions.

More than two decades of peer-reviewed studies have

provided strong evidence of positive alternatives for

addressing even the most serious behavior

challenges, such as self-injury, aggression, and

property damage.

The success of Positive Behavior Support (PBS) has

been documented across settings, including schools,

family homes, and typical places in the community.

Because PBS is not intrusive or inappropriate for

public places, PBS supports and encourages children

to participate more fully in normal everyday activities

and community life.

PBS, which is based upon a completed Functional

Behavioral Assessment, is an evidence-based

technology and process for developing effective,

individualized, nonaversive interventions for children

whose behavior challenges us. PBS draws

information from psychology, medical research, and

neuroscience to understand how learning and longterm

behavior change occur.

The goal of PBS is not merely to suppress or

eliminate unwanted responses but to understand and

respond thoughtfully to its cause and/or purpose. The

child can then be assisted to substitute more

appropriate and effective behaviors, including better

ways to make his or her feelings, needs, and choices

known.

The Positive Behavior Support approach also

involves evaluating a child's physical environment

and changing those things or events that are

overwhelming or stressful (e.g., loud noises, crowded

situations, unstructured time, inappropriate

instructional strategies, lack of adaptations in

curriculum). Last but not least, it involves a

commitment to changing attitudes and behaviors on

the part of adults with whom the child interacts.

Learn about Positive Behavior Support

Key Elements of

Positive Behavior Support

(PBS)

PBS is an orientation based on research, one that

aims to build a culture of support by

understanding the function of behavior; creating

individualized and socially meaningful supports;

creating person-centered environments; and

using a collaborative team approach.

To accomplish this PBS focuses on:

• Understanding through Functional

Behavioral Assessment and hypothesisbased

interventions that are selectively

determined based on an individual's

needs, characteristics, and preferences;

• Prevention and early intervention;

• Education and capacity building;

• Utilization of long-term, comprehensive

approaches;

• Involvement and ownership of key

stakeholders; and,

• Commitment to outcomes that are

meaningful for that individual.1

Focusing solely on the reduction of problem

behaviors through the use of positive or negative

consequences, and/or simply reinforcing

appropriate behaviors by itself is not PBS.

Positive Behavior Intervention and Support

involves teaching new skills that replace

challenging behavior over time, assisting the

individual to change his or her interactions

(physical and social), teaching staff to change

their behavior, and must be based on the conduct

of a Functional Behavioral Assessment.

Further resources on PBS can be found on the

APRAIS website www.aprais.org and other sites

listed on page 18 of this guide.

1 Carr, E.G., Dunlap, G., Horner, R.H., Koegel, R.L.,

Turnbull, A.P., Sailor, W., , J.L., Albin, R.W.,

Koegel, L.K., & Fox, L. (2002) Positive Behavior

Support: Evolution of an Applied Science. Journal of

Positive Behavior Interventions, 4, 4-16, 20.

~ 11 ~

Evaluate your child's program

There are important differences between

schools and programs that employ aversive

techniques, restraint, and seclusion, and those

that have made a full commitment to positive

approaches. To evaluate whether a program can

deliver on its promise of positive approaches for all,

parents should observe the following:

Is there clear evidence of positive, involved,

and supportive leadership?

A safe, positive school or other program

requires leadership from the top, as well as

determination that all administrators, teachers

and staff adopt a shared vision of how children

should be nurtured and respected. This creates

a culture of shared goals and shared

communication, encouraging teachers and staff

to support each other and communicate with

parents and children to solve difficult problems.

Do teachers and staff plan ahead rather than

just react?

Implementing aversive techniques, restraint,

and seclusion wastes the time and energy of

teachers and staff, keeping them trapped in a

stressful, reactive posture. The use of negative

interventions on one child also raises the fear

and anxiety levels of other children, setting the

stage for further problems to emerge and

spread throughout the program. Quality service

provision requires teachers and staff to be

organized and proactive. Positive programs

keep staff focused on ways to anticipate and

prevent problems rather than merely

responding to the challenging behavior after it

has occurred.

Do children receive the positive attention,

quality time, and meaningful activities they need

to thrive?

Negative interventions are by nature isolating

and disruptive of human relationships. They

may result in external compliance at the

expense of internal motivation, a condition

known as " learned helplessness. " Restraint and

other negative interventions are also labor

intensive, taking multiple staff members away

from other children and leading to their

neglect. In positive settings the time and

attention of teachers and staff can be more

equitably shared and trusting relationships can

Should Quick Fixes Ever Be

" A Part of This Healthy Plan? "

You've seen it in the ads from the breakfast cereal

industry: a place setting with eggs, toast, milk,

fruit.....and right in the middle a big bowl of

Choco-Crunchies, carefully labeled " a part of this

healthy breakfast. "

Well, it may be a part, now that the photographer

placed it there, but it's certainly not a healthy part!

The same advertising logic is employed by schools

and other programs that try to insert aversives,

restraint, and seclusion into a child's " positive

behavior support plan. "

Like the child drawn to that sugar high, program

staff are attracted to their own quick fix and never

get around to checking out all the healthy, positive

offerings that can be found on the table.

When coercive interventions are permitted they

become the " junk food " of education.

be built. This increases the program's ability to

implement positive behavior support programwide.

Children become self-motivating as they

experience activities that are socially desirable

and academically meaningful.

Do teachers and staff listen to and respect the

children and families they serve?

The acceptance and use of aversive techniques,

restraint, and seclusion reduces the quality of

> services through " program drift. " This is the

> process by which a service culture founded on

> care and support can deteriorate over time into a

> culture of devaluation and coercion. Positive

> programs eagerly seek parents' expertise about

> their child, not parents' consent to use

> dehumanizing interventions on their child.

> Is the program able to attract and keep good,

> dedicated teachers and staff?

> Using aversive interventions, restraint, and

> seclusion as part of children's education or

> treatment plans can reduce the quality of staff and

> lower job retention. Staff are denied the

> satisfaction of developing trusting, cooperative

> relationships with the children they support, find

> themselves locked into increasingly stressful

> encounters with fearful and angry children, and

> are at far higher risk of personal injury.

>

> ~ 12 ~

> Be aware of the warning signs of abuse

> A particular child may be too young to give

> parents information directly, may not speak

> due to his/her disability, or may be

> embarrassed or afraid to " tell on " adults in authority.

> Many children assume that their parents must already

> know and approve of what is being done to them.

> Therefore a lack of specific complaints and

> information from children does not guarantee that

> aversives, restraint, or seclusion are not being used on

> them in their school or program. Parents need to be

> vigilant detectives.

> The Myth of Safe Restraint

> For many years, service providers and staff trainers

> have searched for a perfect, safe method of

> restraint. We now know that no such thing exists.

> Not only are psychological risks present with each

> restraint use, but physical risks now appear to be

> inevitable.

> Children with disabilities can be medically

> complex. Many are chronically ill and may suffer

> from pre-existing conditions such as sleep apnea or

> difficulties in the regulation of body temperature.

> The prevalence of gastrointestinal problems makes

> many children especially susceptible to aspiration

> (choking on food or vomit) under stress. Another

> risk is thrombosis (clots in veins) which can form

> during prolonged restraint in one position. Many

> children are being medicated with pharmacological

> agents that may be cardiotoxic, precipitate

> arrhythmia, or trigger respiratory problems or

> electrolyte imbalances, particularly when they

> interact with the intense agitated states and surges

> of adrenaline that occur during restraint.

> Then there is the human factor. When staff pit

> their body weight against a child's smaller frame,

> especially when the child may be agitated and in

> distress, the result can never be certain. Terrified

> children fight back, and restraint situations can

> escalate rapidly and unpredictably. Staff may

> continue a restraint until the child stops struggling,

> not realizing that the child is actually struggling to

> breathe. There have been many cases in which

> children have died due to restraint for a minor

> incident that escalated out of control.

> For many parents, the

> first clues they see are

> unusual injuries.

> Sometimes a parent

> will find bruising or

> abraded, reddened

> skin on arms, wrists,

> or ankles. There may

> be marks from

> fingernails, rug burns,

> or unexplained

> patterns of abrasions

> and bruises, sometimes hidden under the child's

> clothing, which are unlike the scraped knees and

> elbows children acquire during play.

> Other useful clues can be found in the " incident

> reports " that programs are supposed to send home

> following a problematic episode. If a daily journal or

> diary is sent between school and home, parents should

> note and question too many entries with remarks such

> as " a rough day. "

> Sudden regressions in behavior or the emergence of

> new and unexplained behavior problems may indicate

> psychological distress and offer clues to their origin.

> Newly-emerging behavior may include: sleeplessness,

> increased anxiety levels; emergence of a school

> phobia (especially when the child previously enjoyed

> attending school) or of a more generalized fear of

> leaving home; emergence of specific fears that may be

> related to particular aversive, restraint, or seclusion

> techniques (such as fear of spray bottles, seatbelts, or

> closets); appearance or intensification of selfinjurious

> behaviors; a sudden change in weight;

> decrease in sociability; and increased aggression or

> emotional outbursts.

> Note: The warning signs of abuse may be attributable

> to other hidden causes, such as sexual abuse. Such

> activity can be particularly difficult to discover, but

> unlike aversives, restraint and seclusion these types of

> abuses are illegal in all states.

> As with any sudden change in a child's everyday

> habits and ability to cope, it is important to see a

> doctor or other professional to rule out other possible

> causes.

>

> ~ 13 ~

> Act promptly to stop abuse

> It is important that you make it clear to your

> child's teachers or other program staff that

> you expect an environment free of aversives, nonemergency

> restraint, and seclusion. You should also

> expect the elimination of emergencies to be a priority.

> To put this message on record, sign and date the " No

> Consent Form " in this publication and have it placed

> prominently in your child's IEP or treatment plan.

> If you have seen warning signs which you believe may

> result from the way your child is treated at school, or

> in any situation where you are not present, it is

> important to ask questions immediately.

> Review your child's records (especially the contents of

> the education and/or treatment plan, and any

> " incident reports " in your child's files), and make

> visits during which you carefully observe all aspects of

> your child's day.

> Keep careful records. Document and date anything

> your child says or does that concerns you; take and

> date photographs of any suspicious injuries.

> Share your concerns with your child's physican,

> psychologist, or other health care provider.

> There are a number of ways to report abusive

> practices and seek help:

> If you have witnessed, or have evidence of abuse

> of a child, you have the right to call the police. The

> rule of thumb is: if you would call for police

> intervention to stop this from happening to a child

> without disabilities, you should call to stop it from

> happening to a child with disabilities.

> Your State Education Agency (SEA) will have a

> help line, hot line, or other assistance program to

> which you should report at once.

> Disputes involving your child's rights under the

> Individuals with Disabilities Education Act (IDEA),

> state special education regulations, or state school

> disciplinary laws and regulations can be addressed

> through an impartial due process hearing. You have

> the right to request a hearing concerning your

> child's placement or program at any time, and your

> request must be granted promptly. Your request

> requires a statement of the problem, and a proposed

> The Protection and Advocacy System

> The Protection and Advocacy (P & A) System is a

> nationwide network of congressionally mandated

> disability rights agencies. It has long been involved

> in redressing improper aversive practices,

> restraint, and seclusion. These agencies, which

> can be found in each state, provide helpful

> information to parents and consumers on these

> issues, as well as direct legal representation and

> referrals to other advocates.

> A primary mandate of each state's P & A office is to

> investigate abuse and neglect of persons with

> disabilities in all settings and to pursue administrative,

> legal, and other appropriate remedies to

> ensure the protection of their rights.

> More information on the P & A System, along with

> contact information for all P & A's nationwide, may

> be found at www.ndrn.org.

> solution. A parent who wishes to file a request for

> due process should make sure they have included all

> required information and may need to consult an

> attorney or experienced advocate for advice on how

> to proceed.

> The Office for Civil Rights (OCR) in the U.S.

> Department of Education provides the primary

> administrative enforcement for Section 504 of the

> Rehabilitation Act and for the Americans with

> Disabilities Act (ADA), two civil rights statutes that

> address discrimination, equal access, and

> reasonable accommodations, as these laws apply to

> schools. Section 504 prohibits discrimination

> against persons with disabilities on the basis of their

> disability. To demonstrate violation of Section 504,

> parents would need to show that aversive

> techniques, restraint, or seclusion were used on

> students with disabilities who engaged in certain

> behaviors, but were not used on students without

> disabilities when they engaged in similar behaviors.

> The ADA

addresses the need for accommodations

> and access in public places and might be involved,

>

> ~ 14 ~

> for example, if a student is restrained or secluded

> " for his or her own safety " when environmental

> modifications would have made this unnecessary.

> Complaints about the use of restrictive and unsafe

> practices, and lack of the accommodations that

> would make these practices unnecessary, can be

> lodged with OCR for investigation. If necessary, all

> OCR and SEA hearing reports may also be

> appealed to federal court.

> Complaints under the Civil Rights of

> Institutionalized Persons Act (CRIPA) can be made

> to the Civil Rights Division of the U.S. Department

> of Justice (DOJ). CRIPA gives the DOJ authority to

> bring legal action against state and local

> governments for permitting dangerous conditions

> and unsafe practices that violate the civil rights of

> persons placed in publicly operated facilities,

> including schools.

> States also may have public interest education

> law projects and disability law projects that can

> provide you with important information and may be

> able to provide direct advocacy.

> Some states have established an Office of the

> Child Advocate to investigate allegations of

> systemic abuse and neglect of children within that

> state's service systems. This can be an important

> contact, especially when a group of parents comes

> forward with similar complaints.

> All 50 states, The District of Columbia, Puerto

> Rico, and the federal territories have a protection

> and advocacy system (P & As). P & As are mandated

> under various federal statutes to provide protection

> and advocacy on behalf of individuals with

> disabilities. To find your state P & A contact

> information go to the National Association of

> Protection and Advocacy Systems website

> www.ndrn.org or call 202-408-9514.

> Until all children with

> disabilities are equally

> protected under the law

> from abusive practices —

> regardless of their disability,

> where they live, or which

> funding stream serves them

> — parents will need to

> employ a combination of

> these approaches to ensure

> their child's safety.

> The Segregation

> Connection

> What would you do if

> you witnessed a child

> being slapped by

> adults or found that

> your neighbor's child

> was locked in a

> closet? You most

> likely would be

> outraged and seek

> help. Teachers and

> other service

> providers would face

> the same public

> outrage if their use of

> aversive interventions,

> restraint, and seclusion were on public display.

> Because the classrooms and programs that use

> these procedures are overwhelmingly segregated

> and easily hidden from public view, most people

> do not know that these things go on.

> States and service systems that have the most

> tolerance for aversive techniques, restraint, and

> seclusion tend to have the least inclusive schools

> and the fewest community living opportunities.

> The more these coercive techniques are used, the

> easier it is for professionals to convince

> themselves and others that segregation is

> inevitable.

> Many advocates believe that the problem of

> aversives, restraint, and seclusion is closely

> connected to the problem of segregation. They

> believe that the safety of people with disabilities

> depends on their ability to enjoy visible and

> valued lives in their neighborhood schools and

> home communities. As families work to keep their

> children safe, it is important to remember that

> safety depends not only on statutes and

> regulations. It depends on inclusion in a wide

> network of caring relationships.

>

> ~ 15 ~

> This is a sample letter for parents to give to their school to deny

> permission to use aversive procedures. It is

> adapted by TASH from a letter written by Tricia and Calvin Luker of

> The RespectABILITY Law Center.

> Please feel free to change and personalize to best fit your

specific

> needs. This letter is available

> electronically at www.aprais.org

> (Your address)

> (School District) (Your telephone number)

> (Address) (Date)

> Re: child's name and birthdate

> Dear (Principal, Program Director, or IEP Team Leader):

> My child, child's name, is a ________ grade student at ______

school.

> Child's name has a disability (or insert label)

> and is receiving special education services. I want to thank you

for

> all of the help and positive support you and the

> teachers and staff at name of school have provided child's name

over

> the years.

> We are concerned that child's name's behavior challenges are being,

> or might in the future be, addressed in part

> through the use of aversive interventions, restraint or seclusion

> (including seclusionary time-out or procedures referred

> to as " physical management " or " restrictive

procedures " ). Examples

of

> these practices include, but are not limited to:

> forcible holding or dragging, the use of ties or straps, sprays in

> the face, slaps, deliberate humiliation, deprivation of

> nutrition or exercise, and time out rooms. This letter is to make

> clear that I have not authorized and will not consent to

> any activity that involves the use of any of these procedures at

> school or while child's name's is transported to or from

> school. I know that The Individuals with Disabilities Education Act

> (IDEA) creates a presumption in favor of positive

> methods, requiring an IEP team to consider using positive behavior

> interventions and strategies when addressing a

> child's behavioral concerns If the school feels child's name's

> behavior is so challenging that aversive or restrictive

> procedures, seclusion, time out, physical management, or restraint

> are being considered or used, it is clear to me that

> there is need for a FBA and the development of an effective PBS

plan.

> I expect to participate in this assessment and the

> development of a PBS plan for my child.

> I am sure you are aware of the number of news reports in recent

years

> describing the deaths, trauma, and injury of

> children with disabilities while or just after being subjected to

> aversive interventions, restraint, or seclusion. I am

> writing this letter as a precautionary action and to provide clear

> instructions that none of these techniques are to be used

> with my child. If any of these techniques are currently being used,

> or have in the past been used, it is important that you

> notify me of this and terminate any use of such procedures

> immediately.

> If child's name's behavioral issues are a challenge now or at any

> time in the future, I am requesting that a behavior

> support team meeting be convened to discuss these challenges, plan

> for an FBA across environments, and begin work

> toward establishing a positive behavior program to address child's

> name's particular needs. I wish to exercise my right

> to participate in all such meetings.

> I want to work with you and with child's name's teachers and

> professionals at name of school to be sure that child's

> name learns to develop positive behavioral skills in an environment

> that is safe for him/her, for his/her peers, and for

> school personnel. I, like you, want my child's school to be a safe

> and secure environment where all students can learn. I

> want to work with you to help create that environment.

> Sincerely,

> (Your name)

> No Consent Form

>

> ~ 16 ~

> JOIN WITH OTHER ADVOCATES

> NATIONWIDE TO END ABUSIVE

> INTERVENTIONS

> According to the National Association of

> Protection and Advocacy Systems (NAPAS)

> 2004 Annual Report, the misuse of restraint

> and seclusion has resulted in hundreds of deaths and

> thousands of injuries in recent years. Children with

> psychiatric, cognitive, or other disabilities are

> especially vulnerable. These abusive interventions

> can re-traumatize people who have a history of abuse

> or assault, and rob individuals of their dignity.

> The President's New Freedom Commission on Mental

> Health (July, 2003) found that high restraint rates

> should be considered as " evidence of treatment

> failure. " The Commission noted that while many

> facilities and state agencies have had substantial

> success in reducing the use of restraint, " much work

> remains before this cultural change can occur. " The

> Commission recommends that states develop

> mechanisms to report deaths and serious injuries

> resulting from the use of restraint and seclusion,

> ensure that investigations of these incidents occur,

> and track patterns of restraint use.

> The Alliance

to Prevent Restraint, Aversive

> Interventions, and Seclusion (APRAIS)

> has been founded by major national and state

> disability organizations to address prevention from

> several directions. We are working at the national

> level to assure children with disabilities of equal

> protection across funding streams and service delivery

> settings, and of adequately staffed and funded systems

> of reporting and accountability to back up these

> protections. We are working to convince the states to

> raise the bar on child safety. And we are partnering

> with individual parents and advocates, encouraging

> them to support and inform each other and to act as

> local watchdogs.

> Keep APRAIS informed, through the web site

> www.aprais.org, of what is happening in your state or

> to your family, or to submit a picture or story. In turn,

> we will keep you informed of upcoming opportunities

> to bring about long-overdue changes in the laws and

> regulations that should protect our children.

> Join with other advocates

> www.aprais.org

> Inequality in Child Protection

> A commitment to the safety of children means

> that ALL children must be protected from

> dangerous and demeaning interventions. Yet

> we still live in an environment that tolerates

> unequal protection. Across the states, across

> service delivery systems, and across disability

> labels, child protections vary widely for no

> logical reason.

> A child with disabilities may lose vital

> protections simply by moving out of the

> foster care system and into a residential

> facility, or may gain regulatory protections in

> the classroom when his family moves to

> another state. Families are often unaware of

> the losses or gains in rights that may occur

> when their child moves to a different state or

> service system.

> Children without disabilities generally enjoy

> far greater protection than their siblings and

> peers with disabilities. Even among children

> diagnosed with disabilities, some are safer

> than others. Children with severe disabilities,

> who are presumably the most vulnerable, are

> also the most likely to be subjected to the

> most stressful, frightening, and dangerous

> interventions.

>

> ~ 17 ~

> Calvin Wade

> Baccus

> Logan Gentry

> There are no uniform requirements for schools,

> public or private agencies, or residential facilities to

> report injuries or deaths of the children or youth they

> serve. This makes determining the size and scope of

> the problem quite difficult. A preliminary effort to

> gather data was made by M. Weiss and the

> investigative reporters of the Hartford Courant as

> part of their ground-breaking series " Deadly

> Restraint, " published beginning October 11, 1998.

> The data in that article indicate that 142 restraint

> deaths were recorded across the country between

> 1988 and 1998. Adolescent youth were

> disproportionately represented in this data. In

> addition, The Courant commissioned a statistical

> estimate from the Harvard

Center for Risk Analysis

> which estimated that between 50 and 150 deaths from

> the use of restraint occur each year - that is 1 to 3

> deaths per week.

> Take time to inform and educate state and local policy

> makers about your experiences and concerns regarding

> the need to eliminate the use of restraint, seclusion,

> and aversive procedures from your child's school or

> support programs. Advocate for high quality

> educational services and programs that practice positive

> approaches and respectful, person and family-centered

> problem solving to address challenging behaviors.

> The children pictured here are just a few of the too many

> individuals who were hurt or who died " in the name of

> treatment. " This guide is dedicated to them and to their

> families, and all other victims of abuse who are unknown

> and whose stories are unreported.

> Logan, who was labeled with

> autism, went through an extended

> period of time where he was

> educated alone in the bowels of a

> high school football stadium.

> Physical restraint was used against

> him whenever he resisted staff

> direction.

> , was victimized by seclusion

> and restraint as an eight-year-old.

> had epilepsy and cognitive

> disabilities. The school forced her

> to wear a seat belt during class,

> causing her a greater injury during

> a seizure. The school also placed

> her in a time-out/seclusion room a

> number of times. When

> banged on the door to be released

> school personnel taped her hands

> behind her back and when she

> screamed they slapped her.

> was a very bright, active boy

> who had read every Tom Clancy

> book and most of

> Crichton's He would act out and

> cause distractions in school,

> possibly due to boredom. Because of

> his behavior he was home schooled,

> then placed against his parents

> wishes in a residential facility on

> May 11, 1993. On May 12th he was

> restrained, causing him to pass out.

> died on May 13, 1993. He

> was 12 years old.

> , who was labeled with

> autism, is remembered by family

> and former teachers as an active,

> curious, sociable, and funny child.

> At age 13 's residential

> school placed him in splint-like

> arm restraints (citing concerns that

> he was picking at his skin), later

> adding a large hockey mask.

> Against the protests of his parents,

> he was made to wear these

> restraints during the day and at

> times during the night. In addition to mechanical restraint,

> was frequently chemically restrained with medication.

> He spent many days lying listlessly on the floor, until one day

> staff could not obtain vital signs. In 2002, died of

> pneumonia and sepsis after 16 months of restraint.

> Goodman

> Tallman

> Calvin, who was labeled with

> Prader Willi Syndrome and

> associated cognitive disabilities,

> died while being restrained at

> school in December 2003, just

> days short of his 13th birthday.

> How big is this problem?

>

> ~ 18 ~

> Resources

> References:

> Achieving the Promise: Transforming Mental Health

> Care in America.

Final Report, July 2003.

> Available online: http://

> www.mentalhealthcommission.gov/reports/FinalReport/

> downloads/FinalReport.pdf

> Bambara, L.M., Dunlap, G., & Schwartz, I.S. (2004).

> Positive Behavior Support: Critical Articles on

> Improving Practice for Individuals with Severe

> Disabilities. PRO-Ed, Inc and TASH.

> Available to order online at www.tash.org

> Bazelon Center for Mental Health Law (2003).

> Suspending Disbelief: Moving beyond punishment to

> promote effective interventions for children with mental

> or emotional disorders. Washington,

D.C. Available

> online: www.bazelon.org/issues/children/publications/

> suspending/suspendingdisbelief.pdf

> Kennedy, S.S. & Mohr, W.K. (2001). A prolegomena

> on restraint of children: Implicating constitutional

> rights. American Journal of Orthopsychiatry, 71(1),

> 26-37.

> Available online: www.sheilakennedy.net/everything/

> ChildrensRights.html

> Mohr, W.K., Petti, T.A. & Mohr, B.D. (2003). Adverse

> effects associated with physical restraint. The

> Canadian Journal of Psychiatry, 48, 330-337.

> Available online: www.cpa-apc.org/Publications/

> Archives/CJP/2003/june/mohr.pdf

> National Technical Assistance

Center for State Mental

> Health Planning (2002). Eliminating the Use of

> Seclusion and Restraint: Special Edition of NTAC

> Networks. andria, VA.

> Available online: www.nasmhpd.org/general_files/

> publications/ntac_pubs/networks/SummerFall2002.pdf

> , B.D., Pollard, R.A., Blakley, T.L., Baker, W.L.,

> & Vigilante, D. (1995). Childhood Trauma, The

> Neurobiology of Adaptation and Use-Dependent

> Development of the Brain: How States Become Traits.

> Infant Mental Health Journal, 16, 271-289.

> Available online: www.trauma-pages.com/perry96.htm

> Turnbull, H.R., Wilcox, B.L., Stowe, M., Raper, C., &

> Hedges, L.P. (2000). Public Policy Foundations for

> Positive Behavioral Interventions, Strategies, and

> Supports. Journal of Positive Behavioral

> Interventions, 2, (4), 218-230. Available online: http://

> www.beachcenter.org

> Turnbull, H.R., , B.L., Turnbull, A.P., Sailor, W.,

> & Wickham, D. (2001). The IDEA, positive

> behavioral supports, and school safety. Journal of Law

> and Education, 30(3).

> Available online: http://www.findarticles.com/p/

> articles/mi_qa3994/is_200107/ai_n8985622

> U.S. General Accounting Office (1999). Improper

> Restraint or Seclusion Places People At Risk. (GAO

> publication HEH-99-176). Washington,

D.C.:

> USGAO.

> Available online: www.gao.gov/archive/1999/

> he99176.pdf

> Weiss, E.M. (1998). Deadly Restraint: a nationwide

> pattern of death. Hartford

Courant, October 11-15.

> Available online: www.copaa.net/newstand/day1.html

> Web sites offering further information on Positive

> Behavior Support:

> www.pbis.org – This web site of a Technical Assistance

> Center on Positive Behavior Interventions and

> Supports is funded by the U.S. Department of

> Education.

> www.rrtcpbs.org - The Rehabilitation Research and

> Training Center

on Positive Behavior Support,

> headquartered at the University

of South Florida, is

> also funded by the U.S. Department of Education.

> www.apbs.org – The Association for Positive Behavior

> Support is an international membership organization

> dedicated to expanding knowledge and dissemination

> in the field.

> www.beachcenter.org – The Beach Center on

> Disability provides family-friendly, research-based

> information on positive approaches and school issues.

> www.icdl.com - The Interdisciplinary Council on

> Developmental and Learning Disorders (ICDL) offers

> research and training in positive approaches to

> supporting the development of children's capacities to

> relate, communicate, and problem-solve.

> www. tash.org - TASH is a membership association

> focused on the elimination of barriers to full inclusion.

> TASH has extensive research and information relating

> to positive behavior support.

>