Fwd: [SpEdVoters] NYCLU Testimony: NYSED Aversives Regs.

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Donna ez

[spEdVoters] NYCLU Testimony: NYSED Aversives Regs.

Folks - Here's the NY Civil Liberties Union testimony against the NYS

Ed.

Dept.'s vile aversives regs. I think you should read it and then figure

out, pronto, how to contact your Regent and make it clear that this

reversal

of 35 years of progress in humane treatment of children with

disabilities is

completely unacceptable. - Dee Alpert

Testimony Of Beth Haroules On Behalf Of

The New York Civil Liberties Union

Before The Office Of Vocational And Educational Services For

Individuals

With Disabilities Of The New York State Education Department

Concerning Proposed Regulations Relating To Aversive Behavioral

Interventions

August 14, 2006

My name is Beth Haroules. I am a Staff Attorney at the New York Civil

Liberties Union (NYCLU) and one of plaintiffs' counsel in NYSARC, Inc.

v.

Pataki, more commonly referred to as the Willowbrook case.1 The NYCLU

is the

New York affiliate of the American Civil Liberties Union. The NYCLU has

long

been devoted to the protection and enhancement of those fundamental

rights

and constitutional values embodied in the Bill of Rights. In the

forefront

of those efforts has been our defense of the rights of those

individuals

with mental retardation and/or developmental disabilities under the

Federal

Constitution and the New York State Constitution.

The NYCLU, with others, commenced the Willowbrook lawsuit in 1972 to

correct

the inhumane institutional conditions suffered by the residents of the

infamous Willowbrook State School. We successfully argued that the

United

States Constitution guaranteed such individuals the rights to equal

protection and to due process in the decision to institutionalize them;

freedom from abuse and unreasonable restraint within the institution; a

clean, sanitary environment; nutritious food; adequate clothing; decent

medical care; protection from harm; and appropriate treatment or

habilitation to improve their mental condition or to increase their

skills.

After the Willowbrook Consent Judgment was entered on May 5, 1975, the

focus

of the litigation turned to advocacy for the development of standards

guiding community-based services in the least restrictive setting

appropriate to the individual as a means to advance social justice for

people with mental retardation and developmental disabilities. The

standards

established have included the right of New York's mentally retarded

citizens

generally to be free from the imposition of aversive behavioral

controls and

seclusion and restraint techniques. And, for the past quarter century,

the

Willowbrook entitlements have set the standard for the developmentally

disabled in this state and many others.

But, in June, the New York Board of Regents took an enormous step

backward

when it approved " emergency regulations " that permit New York State

schools

to use, on a " child-specific " basis, aversive behavioral interventions

and

restraint and seclusion techniques, including time-out rooms, as

consequences for behavior of children with disabilities who attend New

York

State schools.2 These regulations legitimize the use of aversive

behavorial

interventions, restraints and time out/isolation and seclusion rooms in

every school district and at every state-operated residential school

and

state-approved private school in the entire State of New York. The

NYCLU

litigated the Willowbrook case to end the torture and dehumanization of

individuals with disabilities attending " school " in New York State.

With

hastily passed emergency regulations, the Board of Regents has turned

the

clock back to a time when children with mental or emotional disorders

were

routinely punished for behaviors they generally cannot control.

These regulations now authorize New York State educators to subject

children

with disabilities to noxious, painful, or intrusive stimuli or

activities

intended to induce pain. Personnel would be authorized to apply ice to

children's skin; to hit, kick, pinch or strangle them; to perform deep

muscle squeezes; or to subject them to electric skin shock, and painful

water sprays or inhalants such as amonia. They could also withhold

sleep,

shelter, bedding, bathroom facilities, meals, water, or clothing from

children whose behavior was inappropriate or inconvenient. They could

also

alter fundamental food staples, putting urine in water or Tabasco sauce

on

food, for example. Children could routinely be put into restraint in

non-emergency situations. Children could also be confined to " time out

rooms " from which they could not exit and in which they would stay

unsupervised.

A wide range of safe positive methods are available which are not only

more

effective in managing or redirecting " problem " behaviors, but which do

not

inflict pain on, humiliate, or dehumanize individuals with

disabilities. The

practice of subjecting individuals with disabilities to what are termed

" aversive interventions " to control behaviors that are associated with

their

disabilities is outmoded and ineffective. Aversive behavioral

interventions

and seclusion and restraint practices, including time out rooms, are

punishment and control techniques. These techniques serve no

therapeutic

purpose, much less any educational purpose. They are an extremely poor

substitute for staff and provision of other resources which are

necessary to

provide appropriate treatment and supports for persons with mental

retardation. As punishment and control techniques, these behavioral

" interventions " can be and often are easily abused -- as they were at

the

Willowbrook State School.

The Centers for Medicaid and Medicare Services (CMS) prohibits

non-emergency

restraint use in facilities receiving federal funding,3 as does the

Children's Health Act of 2000.4 Most states have prohibited

non-emergency

restraints and other aversives for years. All mainstream state and

national

disability rights organizations oppose the use of painful aversives and

seclusion and restraint techniques. The accepted norm is: if it cannot

be

done to non-disabled children or adults then it cannot be done to

vulnerable

individuals with disabilities. Imagine the outcry if a teacher tied a

non-disabled student down or methodically squirted water into her face

and

up her nose to " change her behavior " in the classroom. Consider how

quickly

the police would be called and ACS or another county youth protection

agency

would intervene if a parent administered electric shocks with a cattle

prod

to his child to make him " behave " at the playground. Children and

adults

with disabilities deserve the same compassion and protection.

New York State knows better and can do better than this. While these

emergency regulations set forth a regime where the child's record may

be

" papered " with behavioral justification and there are several layers of

review of the articulated need for aversive interventions prior to such

use,

no amount of regulating levels of approval, oversight and monitoring,

and

parental consent can remedy the fact that there is no place for

aversive

behavioral interventions and seclusion and restraint techniques in any

educational milieu. The NYCLU urges the Board of Regents to revoke

these

regulations and to prohibit completely the use of aversive behavioral

interventions and seclusion and restraint techniques in all New York

State

public and private schools.

Aversive Behavioral Interventions and Seclusion and Restraint

Techniques Are

Abusive, Barbaric and Outmoded and Serve No Therapeutic Purpose -- The

Mandated " Gold Standard " in Educating Children with Emotional and

Behavioral

Problems is Positive Behavioral Interventions and Supports (PBIS)

The use of aversive behavioral interventions and restraint and

seclusion

techniques on children with cognitive and other mental disabilities is

especially unacceptable given the unique functional characteristics of

these

persons. Behavioral programs using aversive behavioral interventions

and

restraint and seclusion techniques focus only on the behavior itself,

and do

not consider the core issues causing the perceived unacceptable

behavior.

Aversive behavioral interventions and restraint and seclusion

techniques

also ignore the neurological context of behavior, frequently targeting

aspects of the disability that are not under the individual's control.

The primary characteristics which distinguish persons with mental

retardation from the rest of us are limitations on their functional and

intellectual capacities. These limitations vary from one individual to

another and are the fundamental consideration in the design of

treatment

strategies and supports. Research on the function of behavior problems

in

persons with severe disabilities demonstrates that some behaviors may

be

perceived by others to be undesirable but may actually represent a

response

to environmental conditions and, in some cases, a lack of alternative

communication skills.5 Services should include behavioral and

environmental

systems of supports that will enhance the person's independence and

self-determination (ability to make choices). Such an approach is

administratively complex. It requires an investment of time and

resources

including intensive staff involvement and creation of appropriate

environmental supports. Because the functional capabilities of

individuals

with mental illness and mental retardation constantly change in

response to

environmental and other factors, programs of services and supports

require

continual reassessment and adjustment.

Administratively, it might appear to be easier to use punishment and

control

techniques, such as aversive behavorial interventions and seclusion and

restraint techniques. In reality, the use of such interventions

contradicts

and undermines the success of appropriate long-term treatment

approaches for

persons with mental illness and mental retardation. Aversive behavioral

interventions and restraint and seclusion techniques are merely a

substitution for staff and provision of other resources which are

necessary

to provide appropriate treatment and supports for persons with mental

disabilities. As such, aversive behavorial interventions and seclusion

and

restraint techniques are used merely for administrative convenience and

this

use can be easily abused.6

In 1997, Congress amended the federal law that mandates " free and

appropriate education " for all children with disabilities, the

Individuals

with Disabilities Education Act (IDEA), 20 U.S.C. § 614(d)(3)((i).

The law

explicitly mandated that school districts focus on prevention of and

early

intervention in problem behavior. As the U.S. Department of Education

stated

in its comments on the amendments' implementing regulations, " IDEA now

emphasizes a proactive approach to behaviors that interfere with

learning. " 7

The U.S. Department of Education noted that a " key provision " of IDEA

'97

mandates using positive behavioral interventions and supports to help

children with disabilities avoid engaging in behaviors that result in

disciplinary actions and prevent their participation in the classroom.8

In a

recent report, the renowned Bazelon Center for Mental Health Law noted

that:

One of the most significant changes targeted services and supports for

children and youth with emotional and behavioral problems. The IDEA

'97, as

the amendments are known, specifically mentioned two important tools

for

addressing these problems: Functional Behavioral Assessments (FBAs) and

Positive Behavioral Interventions and Supports (PBIS). The inclusion of

these concepts in the statute was both revolutionary and

unremarkable-revolutionary because the federal government had never

before

explicitly required use of these practices, and unremarkable because

professional literature reports the successful use of these techniques

for

more than 25 years.

See 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. (emphasis

supplied).9

Bazelon's report is instructive. It emphasizes the fact that to help

school

districts implement the new IDEA mandate, the federal government

established

the OSEP Technical Assistance Center for Positive Behavioral

Interventions

and Supports, which has several partner sites around the country.10

Bazelon

points out that these sites review and make accessible the professional

literature on FBAs and PBIS, conduct research on the effectiveness of

PBIS,

and provide significant technical assistance at the request of school

districts. One site, for example, has worked with schools to develop

school-wide behavior management programs that are not limited to

students

with disabilities and has studied the positive impact on school-wide

discipline and other beneficial effects, such as improved attendance.11

PBIS are " procedures based on understanding why challenging behavior

occurs " -i.e., what function does the behavior serve to the child using

it?12

According to the OSEP Technical Assistance Center, PBIS is " first and

foremost an ongoing problem-solving process. " It includes assessment

leading

to the design of effective approaches that will reduce impeding

behavior(s)

and/or teach new skills and the development of " supports " to help the

child

maintain the resulting positive changes in behavior.13 Importantly,

" nterventions that result in humiliation, isolation, injury and/or

pain

would not be considered appropriate. " 14

According to OSEP's Technical Assistance Center on PBIS, a significant

body

of research has " demonstrated the efficacy of PBIS in addressing the

challenges of behaviors that are dangerous, highly disruptive, and/or

impede

learning and result in social or educational exclusion, " such as

self-injury, aggression, and property damage.15

Aversive Interventions and Non-Emergency Restraint and Seclusion

Techniques

Violate Individual Rights.

As noted above, the NYCLU does not believe there are justifiable

reasons for

using aversive interventions, and non-emergency restraint and seclusion

techniques. The use of aversive interventions, non-emergency restraint

and

seclusion techniques under the guise of therapeutic or educational

interventions 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. Moreover, the use of procedures may

cause physical and/or psychological harm, are dehumanizing and restrict

the

individual's right to dignity and self-determination.

Under all of these circumstances, we believe that the use of aversive

interventions and non-emergency restraint and seclusion techniques is

violative of an individual's equal protection and due process rights

and

constitutes demeaning, demoralizing, and dehumanizing treatment, rising

to

the level of cruel and unusual punishment under the Eighth Amendment to

the

federal Constitution and Article I, Section 5 of the New York State

Constitution. We also believe that such practices violate several

international human rights conventions, including the Universal

Declaration

of Human Rights, the International Covenant on Civil and Political

Rights,

and the Convention Against Torture and Other Cruel, Inhuman, or

Degrading

Treatment or Punishment.

Expansion Of The Use Of Aversive Behavioral Interventions And Restraint

And

Seclusion Techniques Will Undermine New York State's Leadership Role In

Protecting The Rights Of Individuals With Mental Disabilities

As noted above, there is now broad national consensus amongst mental

health

experts that the use of aversive behavioral interventions and restraint

and

seclusion techniques serve no therapeutic value. And, restraint

techniques

can only be justified, if at all, as an extreme, temporary emergency

safety

measure in response to imminent danger to that person or to others.

The current national trend is toward reducing and, ultimately,

eliminating

the use of aversive behavioral interventions and restraint and

seclusion

techniques in behavioral health care settings. New York State has long

been

recognized to be a national leader in this area. In a September 1999

report,

" Improper Restraint or Seclusion Use Places People at Risk, " and in its

October 1999 testimony before the United States Senate Finance

Committee,

" Extent of Risk From Improper Restraint or Seclusion is Unknown, " the

United

States General Accounting Office ( " GAO " ) praised New York State's

efforts to

protect individuals with mental disabilities who may be subjected to

restraint or seclusion and to reduce the frequency of the use of these

interventions. The GAO, in its report and testimony, pointed to the New

York

State experience as a model for national reforms to ensure the safety

and

well-being of individuals with mental disabilities.

Landmark national legislation, modeled on New York State's, was passed

in

1999 and has led, overall, to tighter controls on the use of restraints

in

all mental hygiene facilities in this country. See " Patient Freedom

from

Restraint Act of 1999, " 42 U.S.C. §§ 591 and 595, now codified at 42

U.S.C.

§ 290ii. Federal and State mental health authorities have since

furthered

the development and implementation of policy change and the active

pursuit

of the reduction and ultimate elimination of restraint and seclusion

ntechniques. See, e.g., " Roadmap to Seclusion and Restraint Free Mental

Health Services, " 2005, in which the Substance Abuse and Mental Health

Services Administration (SAMHSA) outlines its vision to reduce and

ultimately eliminate the use of seclusion and restraint in behavioral

health

care settings available at www.mentalhealth.samhsa.gov/media/

ken/pdf/SMA06-4055/Manual_front.pdf. 16

Yet, at the same time that the use of aversive behavioral interventions

and

restraint and seclusion techniques is being increasingly challenged, if

not

rejected, by the field's leaders and policy makers, the " emergency

regulations " endorse the expansion of its use.

Specific Problems with the Regulations As Drafted that Will Enhance the

Likelihood of Abuse of Students with Disabilities

Without conceding that there is any place for the imposition of

aversive

behavioral interventions and non-emergency restraint and seclusion

techniques in New York State's schools, we offer the following

commentary

with respect to certain specific provisions of the emergency

regulations.

" Appropriate Supervision " of Staff

Section 200.22(f)(4) provides that " [a]ny person who uses aversive

behavioral interventions on students shall receive appropriate

supervision,

including direct observation. " Section 200.6 of the Regulations

indicate

that " when a remedial service is included in the individualized

education

program, such service shall be provided by appropriately certified or

licensed individuals. " Is a behavioral intervention plan including

aversives

a " remedial service " ? What is " appropriate supervision " of school

personnel

who are using " noxious, painful, intrusive stimuli or activities

intended to

induce pain " including electric shock, hitting, and strangling? What is

" appropriate supervision " of school personnel who " withhold sleep,

shelter,

bedding, bathroom facilities, clothing, food, or hydration " or who must

" intentionally alter[.] staple food or drink in order to make it

distasteful " to a child ? There is no requirement that staff, much less

supervisors, possess appropriate clinical background or training.

" Research-based Aversive Behavioral Interventions "

Section 200.22(f)(2)(v) mandates that schools must use aversive

behavioral

interventions that are " peer-reviewed research based practices. " Yet,

the

Department of Education itself has been unable " to identify any

peer-reviewed research which supports " the range of aversive

interventions

used most extensively (i.e., manual and mechanical movement limitation;

contingent food programs and electrical stimulation). See

www.regents.nysed.gov/2006Meetings/ June2006/0606emscvesida1.htm. We

submit

that there is, in fact, no peer-reviewed research based aversive

behavioral

interventions because these interventions are widely perceived to be

both

ineffective and inhumane and dehumanizing.

" Humane and Dignified Treatment "

Section 200.22(f)(2)(i) mandates that a program that uses aversive

behavioral interventions on a child " shall provide for the humane and

dignified treatment of the student and for the development of such

student's

full potential at all times. " The section further mandates that " The

program

shall promote respect for the student's personal dignity and right to

privacy and shall not employ the use of threats of harm, ridicule or

humiliation, nor implement behavioral interventions in a manner that

shows a

lack of respect for basic human needs and rights. "

It is exceedingly difficult to understand how a program that may

include

electric shock, punching, strangling, withholding sleep, shelter,

bedding,

bathroom facilities, clothing, withholding meals, limiting essential

nutrition or hydration and intentionally altering staple food or drink

in

order to make it distasteful to a child, " provide for the humane and

dignified treatment of the student " or " promote respect for personal

dignity and right to privacy. " The regulations provide no guidance in

this

regard.

" Time Out Rooms "

Section 200.22©(3) permits time out rooms to be used without a

" behavioral

implementation plan that is designed to teach and reinforce alternative

appropriate behaviors " in connection with an " emergency intervention. "

" Emergency intervention " is undefined and no strictures are placed upon

the

use of the time out room under such circumstances. Why does this

particular

exception not swallow the other provisions of this subsection ?

Section 200.22©(4) mandates that " parents shall be informed prior to

the

initiation of a behavioral intervention plan which will incorporate the

use

of a time out room. " This section suggests that no parental consent is

required for the use of a time out room.

Section 200.22©(6) mandates that the " time out room shall be unlocked

and

the door able to be opened from the inside. " This information must be

provided to any child who might be placed within the time out room.

Section 200.22©(7) mandates that " staff " be assigned to continuously

monitor the student in a time out room. The federal mandate with

respect to

seclusion/time out rooms indicate that a trained clinician must

continually

monitor and assess the individual's physical and psychological status

by

being inside or immediately outside the seclusion room. Moreover, after

the

individual is removed from seclusion, a physician or licensed

practitioner

who is trained in emergency safety interventions must assess the

individual's well-being. 42 C.F.R. 482.13. The " emergency regulations "

do

not specify what staff member is to be assigned; nor does it specify

the

level of clinical training, if any, that must be possessed by any staff

member assigned to continuously monitor the student who has been placed

in

seclusion.

The " Emergency Regulations " Contradict Similar Federal Regulations

Concerning Restraint and Seclusion Techniques In Many Important Respects

For individuals under 21 in federally-funded residential settings,

governing

federal regulations mandate that " [e]ach resident has the right to be

free

from restraint or seclusion, of any form, used as a means of coercion,

discipline, convenience, or retaliation. " 42 C.F.R. Ch. IV Subpart G.

Yet,

New York's " emergency regulations " permits restraints and time out

rooms to

be used as a means of discipline or coercion.

Governing federal regulations, and the policies of all major mental

health

commissions and agencies, mandate that restraint and seclusion should

NEVER

be used as punishment. 42 C.F.R. 482.13. Yet, New York's " emergency

regulations " allow schools to use restraint and seclusion/time out

rooms as

punishment.

Federal regulations mandate that restraint and seclusion can only be

used

for genuine safety emergencies, and that the restraint or seclusion

must be

terminated as soon as the emergency subsides. 42 C.F.R. 482.13. New

York's

" emergency regulations " allow schools to plan to use restraints and

time-out

rooms for non-emergency situations. The regulations do not limit how

long a

child can be put in restraint or a time-out room. Section 200.22

authorizes

the use of restraint techniques upon a child in non-emergency

situations

where it is included in that child's IEP. The danger of the proposed

legislation is that restraint techniques will be used in non-emergency

situations and will lead to the unwarranted and inappropriate use of

restraint techniques.

* * * * *

Under all of such circumstances, we believe that any New York State

legislation with respect to the use of restraint techniques limit

further or

eliminate entirely the use of aversive interventions and seclusion and

restraint techniques -- not expand the practice as these emergency

regulations would permit.

We urge you to revoke these misguided " emergency " regulations. The

permanent

adoption of a regime which permits adversive behavioral interventions

and

seclusion and restraint techniques to be used on disabled children

attending

school in New York State would signal a retreat by New York State from

its

leadership role in the forefront of the national reform effort in this

area.

Rather we ask that you endorse a wiser course of action by both banning

the

use of adversive behavioral interventions and seclusion techniques and

if

not entirely eliminating at least limiting to emergency circumstances

only

the use of restraint techniques on students attending school in New

York

State. We also urge you to assure that New York State schools are more

adequately staffed by individuals who are fully trained in the latest,

most

appropriate, positive behavioral approaches.

In closing, I want to make clear that my testimony and the accompanying

written statement are not intended as a complete or exhaustive analysis

of

the amendments to section 19.5 of the Rules of the Board of Regents and

the

amendments to sections 200.1, 200.4 and 200.7 and new section 200.22 of

the

Regulations of the Commissioner of Education, relating to behavioral

interventions. I have attempted to identify the NYCLU's principal

concerns

regarding the fundamental policy considerations that must be addressed

before finalizing these major regulatory revisions. We appreciate the

opportunity to express these views before you and we would welcome the

opportunity to elaborate upon our analysis as the Board of Regents

considers

this critical initiative. Thank you.

Footnotes

1 New York State Association for Retarded Children, et al. v. Pataki,

et

al., U.S. District Court for the Eastern District of New York, docket

nos.

72 Civ. 356, 357 (Dearie, J.).

2 Section 19.5 of the Rules of the Board of Regents allows for a

child-specific exception to the prohibition on the use of aversive

behavioral interventions. Section 200.22(e) of the Regulations of the

Commissioner of Education establishes the procedures for a

child-specific

exception to use aversive behavioral interventions to reduce or modify

student behaviors.

3 An interim final rule establishing standards for the use of restraint

and

seclusion in PRTFs providing inpatient psychiatric services for

individuals

under age 21 (the Psych Under 21 rule) was published on January 22,

2001.

The rule also established a Condition of Participation (CoP) for the

use of

restraint and seclusion that PRTFs must meet in order to provide, or to

continue to provide this Medicaid inpatient benefit. The CoP specifies

requirements designed to protect the residents against the improper use

of

restraint and seclusion. Both rules, the interim final and its

amendment can

be accessed on www.access.gpo.gov under the published dates of January

22,

2001, and May 22, 2001. The questions and answers on the interim final

rule

can be found on CMS' website at

www.cms.hhs.gov/Medicaid/services/psyrtf2.asp. The rule is codified and

is

located at 42 CFR Part 483 Subpart G §§ 483.350-483.376. See

www.cms.hhs.gov/SurveyCertificationGenInfo/ downloads/SCLetter04-13.pdf.

4 42 U.S.C. § 595.

5 Durand, V. M., & Crimmins, D.B. (1988). Identifying the variables

maintaining self-injurious behavior. Journal of Autism and

Developmental

Disorders, 18, 99-117; Durand, V. M., & Kishi, G. (1987). Reducing

severe

behavior problems among persons with dual sensory impairments: An

evaluation

of a technical assistance model. Journal of the Association for Persons

with

Severe Handicaps, 12, 2-10.

6 This is the reason that the use of seclusion was outlawed in the

Willowbrook case. The use of seclusion is not permitted in OMRDD

licensed

and operated facilities. 14 N.Y.C.R.R. 624.4©(4). Restraints are used

only

in emergency circumstances or upon a physician's order. 14 N.Y.C.R.R.

624.4©(5). Pursuant to the Willowbrook Consent Judgment and

subsequent

Permanent Injunction, no Willowbrook class member may be subjected to

aversive behavorial interventions.

7 U.S. Department of Education, comments on IDEA '97 regulations, 64

Fed.

Reg. 48, 12 618 (1999).

8 Letter to Anonymous, 30 IDELR 707 (June 16, 1998).

9 Available online: www.bazelon.org/issues/children/publications/

suspending/suspendingdisbelief.pdf.

10 OSEP Technical Assistance Center on Positive Behavioral

Interventions and

Supports

is administered by the University of Oregon in Eugene. See

www.pbis.org/english/index.html. The four additional partners include

the

Beach Center on Families and Disability at the University of Kansas,

www.lsi.ukans.edu/beach/pbs.html, the University of Kentucky, the

University

of Missouri and the University of South Florida.

11 The University of Oregon's program has assisted the Eugene, Oregon

School

District 4J with establishing its Effective Behavioral Support program

in

schools throughout the district. For more information, see

www.4j.lane.edu/ess/ebs/.

12 OSEP Technical Assistance Center on PBIS,

www.pbis.org/english/About_the_Center.htm.

13 Id.

14 Id.

15 See www.pbis.org/english/individual_support.htm. See, e.g.,

Achieving the

Promise: Transforming Mental Health Care in America. Final Report, July

2003.

Available online 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. 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-pc.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

forPositive Behavioral Interventions, Strategies, and Supports. Journal

of

Positive BehavioralInterventions, 2, (4), 218-230. Available online:

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 Lawand Education, 30(3).

Available online: www.findarticles.com/p/articles/

mi_qa3994/is_200107/ai_n8985622. U.S. General Accounting Office (1999).

ImproperRestraint 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 nationwidepattern of death. Hartford Courant, October 11-15.

Available online: www.copaa.net/newstand/day1.html. Indeed, all too

often

the use of restraint techniques results in trauma, injury, and even

death.

See New York State Commission on Quality of Care for the Mentally

Disabled,

Restraint and Seclusion Practices in New York State Psychiatric

Facilities

(Albany, N.Y. 1994).

16 New York has continued its leadership role in this area with respect

to

adult populations. Even now, for example, activities are currently

underway

at the Mid-Hudson Forensic Psychiatric Center, a New York State Office

of

Mental Health operated facility. This forensic facility is developing

an

initiative, in cooperation with the Mental Health Empowerment Project,

aimed

at eliminating the use of restraint and seclusion as a means of control

by

the end of the calendar year 2006.

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[Guest guest]

Thank you Donna this is great info. Around the cornor from my house is a

residence that was built back in the 70s and it houses mostly residents from

Willow Brook.I applied for a job there many years ago. There are no aversives

used in this house and most of the people are so severely disabled I cant see

where aversives would be helpful in anyway.They are all adults and go to

workshop during the day and home at night. They are not really included in

community but their living conditions are wonderful.One woman who likes to

undress in the kitchen is sent to her room until she complies with the being

dressed. After a few months of being sent to her room she gets it. Their rooms

are very nice private rooms and have tvs and all the nicely decorated.Its a home

not an institution and they are one big family with 9 residents.Im told

aggressive clients are medicated none of them look over medicated and this is

the most humane residence for severely disabled people I have seen. When

I first saw these clients they were visably skinny and scared of the staff.

Even if they were non-verbal you could see fear in their eyes when they first

moved here no longer. I just keep praying that NYS is not going

backwards.Families of these residents rarely visit but are amazed at how well

run and happy these clients are. Thanks for this useful info I can keep passing

it around. I have not received any returm emails or phone calls from the

newspaper or tv stations and am still bombarding with this info. Thanks again

Laurie