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Least Restrictive Behavior PPT Dr. Denny

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




               Ken Denny
        Louisiana State University
  What are aversive
   interventions?
 Aversives include any stimuli / environmental
event intended to be unpleasant, cause physical
pain, or humiliate.

Many things can be aversive to an individual and
it is probably impossible to eliminate all of them
from a person’s life!

It is possible and advisable to limit the use
of aversives
Some aversives have
   long histories
             Aversives
Nationwide, federal data indicate that 41,972
special education students received corporal
punishment in the 2006-2007 school year.

Special education students receive corporal
punishment at disproportionately high rates. For
instance, in Texas, the number of special
education students who were paddled in the 2006-
2007 school year amounted to 18.4 percent of the
total number of students who received corporal
punishment statewide.
                  Restraint
•   Restraints involve the forced restriction or
    immobilization of a child’s body or parts of the body to
    achieve a designated behavior using physical,
    mechanical or chemical means, or seclusion.

•   Physical restraints involve the use of physical force by
    one or more individuals that reduces or restricts an
    individual’s freedom of movement, often involving
    various holds designed to immobilize a person or bring
    them to the floor.

•   Mechanical restraints include straps, cuffs,
    body/blanket wraps, helmets and other devices to
    prevent movement and or sensory perception, often by
    pinning a child’s limbs to a splint, wall, bed, chair or
    floor.
       Teaching Tools??




Rifton chairs are
not intended for
   behavioral
    purposes
              Seclusion
•   Seclusion, also considered a form of
    restraint, involves involuntary confinement
    in a room, box, structure or space from
    which the individual cannot escape.

•   Seclusion does not include allowing an
    individual to take a break from an activity,
    to move to a quieter or less stimulating
    location or to enjoy privacy.
            Emergency

•   In emergencies, school personnel are
    permitted to act to control a student’s
    behavior posing a clear and present danger
    of serious physical harm to the student or
    others, and which cannot be immediately
    prevented by a less restrictive response.
 Common myths about
aversives, punishment,
seclusion and restraint
     Myth: Aversives, restraint,
seclusion are effective treatments
 •   Fact:

 •   Our professional literature, research, and
     clinical experience would support that they
     represent the FAILURE of intervention and
     treatment
Myth:    Punishment procedures
     are more powerful than
reinforcement based procedures
•   Fact: Powerful punishers may decrease problem
    behavior rapidly (it’s a fact)

•   BUT:

    •    punishment does not teach appropriate
        behavior

    •   can serve as an inappropriate model

    •   can make the punisher punishing!

    •   has problems with maintaining and
Myth: Punishment will keep
                  people safe
Fact– procedures are misused and abused; children are
being hurt and are dying

   142 deaths found from 1988 to 1998, reported by the Hartford
   Courant

   50 to 150 deaths occur nationally each year due to seclusion
   and restraints estimated by the Harvard Center for Risk
   Analysis (NAMI, 2003)

   A growing list of additional children on the on the Restraint
   DEATH List maintained by the COALITION AGAINST
   INSTITUTIONALIZED CHILD ABUSE
    Myth:   If everything we (schools)
have tried has failed that is sufficient
   to use punishment or restrictive
                procedures proven safe,
• Fact – Decades of research have
    positive methods of changing and re-directed
    behavior to be successful regardless of a child’s
    diagnostic label, degree of disability, or severity of
    problematic behaviors.

•    School personnel need to be trained in and use
    research-validated methods for promoting positive
    behavior change and crisis de-escalation.
Just because it might work doesn’t mean you
should do it!
There are interventions / treatments
that should be rejected :

        Because they dehumanize and stigmatize
      the individual

        Because they violate community/ family /
      individual acceptance

       Because they inflict intentional emotional
      or physical pain

       Because they do not leave the individual
      “better off” , more independent, and/or
      happier
9 Year Old Arrested at School
        (WINK News 10/15/08)



                           A   9-year-old girl was
                       arrested at Royal Palm School
                        on Tuesday and is now facing
                       two felony charges for battery
                       on an education employee. The
                        report says the girl purposely
                       spit on her two teachers while
                          they tried to control her.
   State of the States
forty-one percent (41%) have no laws, policies, or
guidelines concerning restraint or seclusion use in
schools;

almost ninety percent (90%)still allow prone
restraints,

only forty-five percent (45%) require or recommend
that schools automatically notify parents or
guardians of restraint/seclusion use

(National Disability Rights Network, 2009)
Ryan, Peterson, and Rowalski
           (2008)
Fifty percent (12 of the 24) policies which were
identified required school systems to develop written
procedures for the use of seclusion

16 (67%) established requirements for rooms used for
seclusion. A smaller number banned the use of locked
timeout rooms.

Fifteen (62%) required parental notification of the use
of seclusion timeout, and an even larger number (21 or
87%) required documentation of each timeout event.

Fifteen (62%) also recommended or required staff
training if seclusion timeout was to be employed.
Ryan, Peterson, and Rowalski (2008)

 Fifteen of these state policies also addressed the length of time
 students would be in timeout.

    Four (17%) specified 12-15 minutes maximum (at least for
    elementary aged students)

    six (25%) required a 20-30 minute maximum or that students
    must at least be reassessed after that period of time. Four
    more specified 55-60 minutes as the limit.
          A call for action
Because there is no monitoring on a national level, the full
extent of death, injuries, and harm from the use of these
techniques is unknown.

Although some states have standards and regulations
regarding restraints, seclusion and aversive interventions,
the existing laws are not uniform and may not be enforced.
Other states provide little or no protection for children at all.

Districts could restrict procedures (several do) through local
policies and procedures . Key is not to wait for a situation to
occur
          Louisiana
Currently Louisiana provides no policy or
guidelines for schools in:

    Seclusion

    Restraint

    Aversive Interventions with students
    with disabilities
    Principles that Guide the
     Selection for Behavior
            Reduction
•   Principle of least intrusive alternative

    •   Select the intervention that is least
        intrusive and still effective

    •   Selected intervention should be based
        on the identified function of the
        challenging behavior
Hierarchy of Procedural Alternatives
       for Behavior Reduction
         Level I    Strategies of differential reinforcement
              A. Differential Reinforcement of Low Rates of Behavior (DRL)
                B. Differential Reinforcement of Other Behavior(s) (DRO)
              C. Differential Reinforcement of Incompatible Behavior (DRI)
             D. Differential Reinforcement of Alternative Behavior(s) (DRA)
                           E. Noncontingent Reinforcement

         Level II    Extinction (terminating reinforcement)
               Level III Removal of desirable stimuli
                             A. Response-cost procedures
                                B. Time-out procedures

           Level IV        Presentation of aversive stimuli
                           A. Unconditioned aversive stimuli
                            B. Conditioned aversive stimuli
                             C. Overcorrection procedures
   Need to
  establish
  hierarchy
      of
intervention
 procedures
  Principles for Developing Legally Correct Seclusion
   Timeout or Physical Restraint Policies (Rozalski et al.,
                      2006; Ryan, Peterson & Rowalski 2007)


1. State Education Agencies should require public school districts to develop policies
and procedures regarding the use of aversives, seclusion timeout, and physical
restraint with all students.

2. Aversive procedures, seclusion timeout and physical restraint procedures should
be included in a student's IEP or Section 504 plan.

3. Seclusion timeout and physical restraint should be used only when a student's
behavior poses a risk of injury to the student, to peers or staff members.

4. Aversive procedures, seclusion timeout and physical restraint should be used only
after less restrictive interventions have documented to not have been successful.

5. State education agencies, teacher training institutions, and public school districts
should develop appropriate pre-service and in-service training experiences so that
staff members who may be required to use seclusion timeout and physical restraint
receive thorough and continuous training in the appropriate use of the procedure.
   Guidelines Continued
6. Teachers should continuously collect meaningful data to document the efficacy
of seclusion timeout and physical restraint.

7. Teacher should keep thorough records when seclusion timeout or restraint are
used.

8. Administrators should develop methods to periodically review and summarize
teacher and school-level data on the use of seclusion timeout and physical
restraint.

9. State education agencies should collect data on the frequency of use of
seclusion timeout and physical restraints in the public schools.

10. State education agencies should explore system-wide alternatives to
seclusion timeout and physical restraint and develop appropriate teacher and
administer training.

Modified from Rowalski, et al., 2006
          Questions ??


•   http://www.lapositivebehavior.com



•   rdenny@lsu.edu

				
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