I’m yet to understand how something that is “aversive” can also be “therapy….”

I’ll never forget the day that I walked into a seclusion room at the school where I worked and closed the door. In that brief moment, I imagined what it might be like to be put in that room against my will. Scratches on the walls, dents in the door… all evidence of the many students who had been there before, fighting with all of their might to calm down.

I cried then, and I still tremble when I think about it. It makes me sick to know that I’ve participated in this “intervention.”

For students with emotional and behavioral needs, the need for restraint and seclusion often becomes a consideration during the IEP process. These students usually have an aversive therapy plan that can be used in those “last resort” situations when the student is a danger to self or others. It’s easy to see why, for many of these students, school becomes such a threatening place and why anxiety sooner or later gets added to the list of diagnoses.

Despite extensive policies and standards designed to address issues with restraint and seclusion, there continue to be stories of injuries and even deaths. These stories often refer to a single incident in which teachers or staff were not properly trained and/or failed to respond appropriately. It’s much less common to hear about the everyday impacts of aversive interventions. What about those students who have experienced repeated restraint or seclusion over several years, and often multiple times per day? Even if teachers are doing everything by the book, there continues to be a tremendous cost.

Post-traumatic stress disorder: add that one to the list of diagnoses…. for the student, the teacher, the parents, and anyone else involved. What are we doing to address the mental health needs that inadvertently become the outcome of this “therapy?”

I think we can all agree that restraint and seclusion are traumatic. Yet our actions don’t always reflect that belief. When a student becomes agitated to the point of restraint or seclusion, the teachers and staff are trained to manage their emotions and to focus on de-escalation. As much as the adult may appear composed on the outside, what goes on internally may be a completely different story. Adrenaline will kick in at some point. Typically, following an incident like this, the student and the adult will have a conversation to “resolve” or “repair” what occurred before returning to class. The goal is to get back to class as soon as possible so that the student doesn’t miss out on any more instruction. The teacher must then put aside any emotion and focus on providing the instruction.

As much as I hate seclusion and restraint, I know that in some cases it is the only way to ensure safety in the moment. But these interventions rarely, if ever, result in new skills. If any therapy is possible with seclusion and restraint, then it is the intentional teaching and support that comes from a positive student-teacher relationship and teams who are committed to understanding what drives the behavior in the first place. Whenever there is an aversive intervention, there must be debriefing with the student and within the team. Debriefing must balance an honest evaluation of what led to the event, what occurred, and what was discovered in the process.

If I had my way, I’d say that every student who has been exposed to aversive interventions should have access to counseling support within the school system, as well as case management facilitation across other providers. Special education teachers and staff need access to ongoing, intensive training and in-the-moment coaching.  More importantly, there needs to greater access to individual and group counseling support for anyone who participates or who has participated in restraint or seclusion.

The long term impacts of the everyday reality for these students and their providers cannot be ignored.

Advertisements

5 thoughts on “I’m yet to understand how something that is “aversive” can also be “therapy….”

  1. When something is described as intervention, it is assumed to have a legitimate research base and evidence that it leads to improved performance or learning. The term “intervention” implies something done repeatedly, which supports the idea that there is a rational implementation and successful conclusion. This certainly contradicts what we do know about any punishment, including aversives, that unless they show immediate or near immediate elimination of the negative target behavior, it is misapplication.

    There is no place for “aversive therapy.” The use of an aversive should be considered a crisis management episode, signaling a behavior support system unequaled to the challenges of the situation. The response of this should not be more aversive behavior on the part of the therapy team, but a call to the team that the current plan as it exists is not effective. There should be an immediate re-analysis of what to do to avoid the use of such non-therapeutic responses. Anything less is professional misconduct.

  2. When in an IEP meeting this is stated as an option it immediately guarantees that it will happen! Even building such a room guarantees that it will be used. There will always be times or with individuals that simply don’t want to bother, and will defer to the path of least resistance. The minimum effort required will become the standard whenever it is allowed.
    To avoid restraint or exclusion requires forethought, a plan, education, and simply a whole lot of hard work that all too often just can’t be bothered with by undertrained or overworked staff. Many times the lack of understanding of the complexities of behavioral approaches means they don’t realize that they may be rewarding a child who wants to be alone, rock, listen to music, get away from other children or the demands being put on them and hence the exclusion rooms serve to escalate bad behaviors instead of reduce them.
    These methods also are often hidden from parents who seem to manage the other 16 hours a day and weekends without ever needing to resort to the same horrendous tactics. This results in the ever-present hostile relationships that develop between parents and schools.
    99.9% of the time they could be avoided or averted with the right knowledge and training plus a little empathy. Would you do this to your own child might be a good question to ask yourself before dragging an innocent child to a rubber room. What would you have done if the room didn’t exist? Pre-emptive positive supports and rewards could avoid most of these situations.
    The bottom line is that to institute and to use restraints and exclusion rooms is to see these children as less than full humans and except in the most extreme emergencies should never be used or implemented at all. But all too often the so-called emergency is really “I don’t have time to bother with you today or make the extra effort to de-escalate this in any other way other than to sit on you, then drag you to a padded seclusion cell.” I personally feel we afford more dignity to convicted felons than to our precious children who are here through no fault of their own. We need to end these practices and put cameras in every special education room in the nation.

  3. Thank you for your comments. This is a loaded topic, but it so important to have dialogue around this issue. I agree that 99.9% (maybe 99.99%) of the time behavioral incidents can be prevented and that better training for teachers is a critical component of this prevention. I believe therapeutic skill building begins when teachers take the time to set aside their own agenda/expectations and to acknowledge what the student might be feeling/needing in the moment.

    Collaborative Problem Solving has shaped my thinking around much of this and has been some of the best training I’ve ever received.

    http://www.livesinthebalance.org/
    http://www.thinkkids.org/

  4. Pingback: Apostrophe Magazine

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s