Stop Abusive Behavior Control
Questions and Answers About APRAIS:
Understanding Aversives, Restraints and Seclusion
1. What are aversive interventions, restraints and seclusion?
Aversives, restraints and seclusion are methods often used to control children who exhibit challenging behaviors in school or treatment centers. Yet research shows that these practices, which include forced immobilization, electric shock and sensory deprivation, are more akin to torture and often harmful to a child’s cognitive, social and emotional development.
More important, parents are often not aware that other options can better help improve a child’s behavior. Positive Behavior Support (PBS) seeks to understand the underlying cause of a child’s negative behavior and develop a positive intervention plan that focuses on the child’s individual needs, as well as socially meaningful supports and a collaborative team approach. Research shows that these positive supports are effective in reducing challenging behaviors by 80 percent in two-thirds of cases.
2. What are aversive interventions?
Aversive interventions involve the deliberate infliction of physical and emotional pain and suffering for the purpose of changing or controlling behavior. Aversives include but are not limited to corporal punishment, deprivation of health-sustaining necessities and treatment of a demeaning nature. Examples include: hitting, electric shock and force feeding; odor therapy using ammonia or other noxious fumes; sensory deprivations such as blindfolds, visual screens or helmets that generate white noise; withholding meals, sleep, water, medication or bathroom facilities; and, verbal abuse or humiliation likely to cause emotional trauma or draw negative attention from others. Syn. aversive practice.
3. What are restraints?
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.
· Chemical restraints rely on medication to dull an individual’s ability to move and/or think. They do not include medication ordered by a licensed physician and administered to treat symptoms of a disability or an illness.
In an emergency, restraints should be used only as a last resort when all other techniques have proven ineffective to prevent imminent serious physical harm. Emergency restraints should be limited to the time that the individual poses a risk of physical harm.
4. What is considered to be 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.
5. Why does APRAIS consider these practices dangerous?
Aversives, restraints and seclusion can cause physical, psychological and emotional damage – and even death. A study conducted by The Harvard Center for Risk Analysis and published by The Hartford Courant estimated that one to three people living in mental health facilities or group homes die each week during or after restraint; that’s equal to 50 to 150 deaths each year.
The President’s New Freedom Commission on Mental Health found that behavioral restraints and seclusion pose significant risks for America’s most vulnerable adults and children, including “serious injury or death, retraumatizing of people with a history of trauma or abuse, loss of dignity and other psychological harm” (Commission on Mental Health [CMH], 2003).
6. What are the dangers associated with using restraints?
Restraints are considered a major risk because they put both staff and the individual who is exhibiting challenging behaviors in a highly confrontational, physically dangerous situation. In a number of cases, the use of restraints has resulted in injury and death. That’s why restraints should only be used in situations where an individual poses a serious risk of imminent physical harm. Even then, only an individual specifically trained and authorized to use restraints should apply such methods.
7. What are the alternatives to using aversive interventions, restraints and seclusion?
Evidence-based research shows that Positive Behavior Support (PBS) has proven effective in reducing challenging behaviors by 80 percent in two-thirds of cases. The PBS model focuses on first understanding the underlying cause of the child’s negative behavior and then developing a positive intervention plan that uses a collaborative team approach to address the child’s individual needs.
As part of the model, staff learn to understand sensory processing differences and environmental stressors that can trigger challenging behaviors and how to interpret those behaviors as a form of communication. They also develop competencies in relationship building and group processes, restraint prevention and methods for de-escalating challenging behaviors, and thresholds for emergency safety interventions.
8. Where are these types of interventions being used?
These dangerous interventions are being used in public schools, treatment centers and residential programs to control the behavior of some of America’s most vulnerable citizens – children and adults with significant disabilities.
In schools, parents have been reporting suspicious school injuries to their state Protection & Advocacy agency and Department of Education for years, yet no specific federal legislation has been passed to establish regulations and procedures for restraints and seclusion in public schools. In 2006, California’s Protection & Advocacy System received eight (8) reports of abusive restraint and seclusion which prompted investigations. In 2007, Colorado’s Protection & Advocacy System ordered the investigation of a Colorado Springs school district after reports of improper seclusion and restraint on 45 different occasions.
A study conducted by The Harvard Center for Risk Analysis and published by The Hartford Courant estimated that one to three people living in mental health facilities or group homes die each week during or after restraint; that’s equal to 50 to 150 deaths each year and 500 to 1,500 over the past decade. In addition, the Coalition Against Institutionalized Chidl Abuse has tracked 75 child deaths due to restraints over the past decade.
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