Judge Rotenberg Educational Center

The Judge Rotenberg Center (JRC, originally founded as the Behavior Research Institute) located in Canton, Massachusetts is a residential facility that uses behavioral treatments, methodologies and educational services to work with children and adults with severe developmental disabilities and emotional or behavioral disorders, through day, residential, and respite programs. JRC states that the center applies the science and technologies of behavioral psychology to the education and treatment of severe behavior disorders, using several basic principles, including near-zero rejection and expulsion policy regardless of severity of behavior or disability, active treatment rather than warehousing, and decreased use of medications and varied rewards programs.

JRC is one of the few schools in the United States currently using aversives (unpleasant stimuli to punish behavior), and the only one using skin shocks as aversives, a controversial practice that has attracted considerable criticism from educators, governmental bodies, and disability rights and human rights groups. While JRC contends that electric shocks are used as a last resort only in cases of violent and self-injurious behavior, a 2006 report by the New York State Education Department found that shocks were used for minor episodes of noncompliance, and that students were not provided with positive behavior supports, contrary to JRC's claims. There is limited peer-reviewed research on the effectiveness and safety of the devices that administer these shocks. In its 2006 Private Special Education School Program Review Report of Findings, the Massachusetts Department of Education found that unsigned Individualized Education Programs (IEPs) were being utilized for students at JRC, and that the school did not have a written policy indicating that it must obtain consent before revising or changing an IEP.

History

The center was founded as the Behavior Research Institute in 1971 by Dr. Matthew L. Israel, a psychologist who trained with B. F. Skinner. In 1994, the center changed its name to the Judge Rotenberg Educational Center "to honor the memory of the judge [who] helped to preserve [the] program from extinction at the hands of state licensing officials in the 1980s." JRC moved from its original location near Providence, Rhode Island to its current facilities in Canton, Massachusetts in 1996. The move allowed an expansion of the numbers of individuals served, as well as a new location in one of the center’s major service areas (Massachusetts).

Behavior modification

The Judge Rotenberg Center provides behavioral treatment using the methodologies of Applied Behavior Analysis (ABA). JRC's goals include a near-zero rejection/expulsion policy regardless of severity of behaviors and/or disability; active treatment with a behavioral approach directed exclusively towards normalization; frequent use of behavioral rewards and occasional use of punishments; minimal or zero use of psychotropic medications; video monitoring of staff; and the option to use aversives, including electric shocks on the skin using a device called a Graduated Electronic Decelerator (GED). JRC is the only institution in the US known to use skin shocks as aversives. There is limited peer-reviewed research on the effectiveness and safety of GEDs, which may be banned as a result of their modification from an FDA-approved device.

Each student and client has an individualized behavior contract which includes specific instructions on the use of rewards and aversives in changing behaviors. The ABA model is adhered to on a 24/7 basis by all direct-care staff and other staff in contact with the residents. Daily notes on the resident’s progress and behaviors are maintained by trained staff and are available at all times to parents and guardians, as well as to referring agencies.

Use of rewards and aversives

The reinforcement, or reward system, used on a daily basis with all residents, offers them the opportunity to earn money through academic achievement, as well as earning participation in desired activities such as on-site arcades, movies, an Internet café, holiday activities, and time spent on both indoor and outdoor basketball courts and playgrounds. Residents also earn special outings with favorite staff members, and off-site field trips to local attractions such as the New England Aquarium and the Franklin Park Zoo, parks and playgrounds, museums, and other trips.

Rewards also include special take-out meals or snacks such as smoothies and lattes. The center also maintains a “contract store” where items of interest to the population, such as clothing, jewelry, and electronic devices such as MP3 players, are available for purchase with money earned as rewards for positive behavior and academic achievement.

Residents can also earn the chance to work onsite, earning money for their efforts while learning how to succeed in the outside world. They also occasionally volunteer locally or work for pay at offsite businesses.

Aversives used to modify negative and unwanted behaviors include: loss of privileges (LOP) (residents lose opportunities to participate in the various activities, field trips, or other rewards as outlined above); pinpointing the behavior (pointing it out to the resident and noting it in his/her daily record; the accumulation of these notes results in loss of privileges); and in the most extreme cases such as self-injury or injury to others, the use of the GED skin shock in limited numbers of residents. Those who may be subjected to the GED include approximately 1/3 of JRC’s over 240 students and clients.

The GED was invented to administer the shocks by remote control through electrodes worn against the skin. Most often the shocks are initiated by trained staff to address high-risk, low-frequency behaviors. The center states that the GEDs are only employed after positive behavioral intervention have not been proven to alleviate violent, self-injurious behaviors. By contrast, a 2006 report by the New York State Education Department found that JRC's use of aversives took place without a significant positive behavioral support program, and that students were not provided positive behavioral supports. The report also found that the GEDs are used when there is no threat of serious physical harm or injury, including failing to follow directions, failing to be neat, slouching in a chair, "nagging", stopping work for more than 10 seconds, and other similar acts of noncompliance. The report claims that one student received 18 shocks in April 2005, with 8 of them (44%) having nothing to do with aggression.

According to William Pelham, a behavioral specialist and director of the Center for Children and Families at the State University of New York at Buffalo, "[p]eople don't use... shock anymore because they don't need to. It is not the standard of care. There are alternative procedures that do not involve aversives like electric shock."

Controversy and investigations

There has been considerable controversy around the use of the GEDs, including calls from some disability rights groups for legal protections against the use of aversives.

The center is one of few facilities in the United States making use of aversives, and the only using the GED, in its treatment to punish undesirable behaviors. However, existing protections in place include:

• A probate court judge must pre-approve an individualized treatment plan authorizing the use of the skin shock and reviews the plan and its results yearly, on a case-by-case basis
• Parents must give their prior informed consent
• The use of skin shock must be included in the student's Individual Service, Education, or Habilitation Plan, and
• A physician, clinician, human rights committee, and peer review committee must also give prior approval

At various points in its history, investigations and lawsuits have been brought against the center’s operations. In 2002, the mother of a former student launched a civil lawsuit against the center after an incident in which the student was restrained for seven hours and shocked many times. A trial finally came about in this lawsuit in April, 2012, with both sides claiming satisfaction with the outcome.

Concerns about the treatment regimen prompted 2005 and 2006 investigations by the New York State Education Department. The resulting report from the final 2006 visit was highly critical of both processes and oversight at the facility. The report found that shocks were used for minor episodes of noncompliance, and that students were not provided with positive behavior supports, contrary to JRC's claims.

In December 2007, the center was found by the Massachusetts Department of Early Education and Care to have been abusive towards residents and failing to protect their health, after two residents were shocked using a GED on the behest of a former student posing as a staff member in an August 2007 telephone call. Video surveillance revealed that one resident was restrained on a 4-point board, a type of mechanical restraint that was court-approved in his treatment plan, but was not authorized by trained staff for use in that moment. In response, the center instituted several reforms including re-training staff; not allowing monitoring staff to call for the use of the GED; appointing new supervisors; regularly reviewing video recordings of staff and instituting random spot checks of staff behavior; new call screening procedures; and the suspension or cancellation of certain punishments for certain residential units, including the use of the GED.

A full investigation of the incident was conducted by Massachusetts authorities and agencies, during which all investigating parties viewed the video tapes multiple times. The originals of the surveillance tapes were then destroyed by Dr. Israel, who believed that there was no further need for them; the state assistant attorney general claimed that Israel had been ordered to keep them.

In May 2011, Matthew Israel was charged with obstruction of justice for misleading a grand jury over the school's destruction of those tapes, as well as being an accessory after the fact. Israel resigned his position at JRC in a deferred prosecution plea deal with the Massachusetts State Attorney General's office. Then-Assistant Executive Director Glenda Crookes became the Executive Director of the Judge Rotenberg Center after Dr. Israel’s resignation.

In 2010, the American human rights organization Mental Disability Rights International (now Disability Rights International, DRI), filed an appeal with the office of the United Nations Special Rapporteur on Torture, stating they believed the residents were being subjected to human rights abuses due to the center’s use of aversives. The then-Special Rapporteur, Manfred Nowak, sent what he described as "an urgent appeal to the U.S. government asking them to investigate." In 2012, a follow-up investigation was undertaken by the United Nations' Special Rapporteur on Torture, Juan E. Méndez, who stated, "It raises a very serious concern. The passage of electricity through anybody's body is clearly associated with pain and suffering. Now it depends on the level and time and whether there's any rationale for it." At that time, the United States Senate’s Health, Education, Labor, and Pension Committee also held a hearing on alternatives to aversive therapies.

JRC replied to a news story on the contents of the DRI appeal, calling the story "nothing more than a regurgitation of the outdated, false, and unproven accusations that have been made against JRC". JRC stated that their treatments were often the last form of treatment for severely affected individuals, and that the treatments free them from "restraint, drugs, self-abuse, and all the severe pain it was causing them, through the use of safe, effective, and far less intrusive behavioral treatment". The reply also stated that the evidence cited in the [M]DRI request grossly misstated information found on JRC website, and misquoted statements made by former students to only show the interventions used while ignoring statements by students that the treatments were effective and permitted them to live better lives, and that "It would be torture to not treat these students and allow them to be chemically restrained and warehoused for the rest of their lives."

As the result of a 2011 ruling by the Massachusetts Department of Early Education and Care, Governor Deval Patrick’s administration imposed rules that only residents whose treatment plans were approved before that time and included the use of the GED, were still permitted to use it. Students and residents entering JRC since 2011 may not have the GED included in their treatment plan.

Parent support and criticism

Parents of difficult and aggressive children have been both highly supportive and critical of the center's practices, even winning lawsuits against their local school districts to keep their child enrolled at JRC; the center has been both praised for the progress that residents have made, while others have criticized and even sued the school based on their use of aversives.

Further reading

• "Observations and Findings of Out-of-State Visitation: Judge Rotenberg Educational Center" (Archive). New York State Education Department (NYSED). June 9, 2006.

External links

• Official website