Overview of ARS

The following frequently asked questions are intended to provide background information on the use of aversive interventions, restraint and seclusion and the stance of APRAIS. If you have additional questions or would like more information, please contact us.

Why does APRAIS seek to eliminate the use of aversive procedures, seclusion, and non-emergency restraint?

Aversive procedures, seclusion and non-emergency restraint are now recognized to be dangerous; leading to injury, death and trauma.

These procedures are still being used as part of treatment plans though no evidence exists for therapeutic value. It is widely accepted that restraint is not treatment; it is the failure of treatment.

The use of restraint, with the exception of brief physical intervention when someone is at imminent risk of hurting himself or others violates 8th and 14th amendment protections.

Statutes and regulations are outdated, confusing, uncoordinated, and protect some while others remain at risk.

What are aversive procedures?

Aversive procedures have some or all of the following characteristics:

Produce obvious signs of physical pain;

Potential or actual physical side-effects such as tissue damage, physical illness, physical or emotional stress;

Dehumanization of the individual;

Significant concern on the part of family members, staff or caregivers regarding the necessity of, or their own involvement in such extreme strategies;

Obvious repulsion, stress or concern on the part of observers who cannot reconcile such extreme procedures with acceptable standard practice;

Rebellion or objection on the part of the individual against being subjected to such procedure;

Permanent or temporary psychological or emotional harm.

Examples of Aversive Procedures Currently in Use:

Contingent Electric Shock [not to be confused with electro- convulsive therapy (ECT); a procedure also subject to misuse]

Extremely loud white noise or other auditory stimuli

Forced exercise

Shaving cream to the mouth

Lemon juice, vinegar, or jalapeno pepper to the mouth

Water spray to the face

Placement in a tub of cold water or cold showers

Slapping or pinching with hand or implement

Ammonia capsule or vapor to the nose

Blindfolding or other forms of visual blocking

Placement in a dark isolated box or other methods of prolonged physical isolation

Ice to the cheeks or chin

Withholding of meals/denial of adequate nutrition

Teeth brushed or face washed with caustic solutions

Prolonged restraint or seclusion

What needs to be done to prevent their use?

By advocates:

Position the issue across and beyond the disability field

Make sure families and individuals know their rights

Seek and support the voices of people with disabilities who have been victims of these methods

Work to make sure positive supports are available so families don’t feel that they have no other choices

By agencies:

Establish a new organizational culture – make elimination of these techniques a priority, track, provide alternate tools and training, reward progress

Make sure restraint is understood by all to be the failure of treatment and that any use signals the need to seek a better understanding of the function of the behavior and response to that function — restraint should not be part of someone’s treatment program

Establish internal policies that don’t permit restrictive and coercive approaches — replace a culture of control with a culture of caring

Address underlying reasons why restrictive and coercive methods continue to be used

Select staff who value cooperation over control

Advocate for funding that allows you to support tougher people so they are not sent out-of-state

On the federal level:

Enact federal legislation that outlaws the use of aversives, seclusion and non-emergency restraint in all settings for all populations

Mandate and fund venues of collaboration across disability fields – analyze models that have worked and disseminate information

Fund research and training in positive alternatives – technology exists but hasn’t made its way into the hands of the people who need confidence and competence in alternate approaches

Develop federal policy assuring that ALL instances of the use of aversives, restraint or seclusion are reported, independently monitored, and that an analysis of possible alternatives is conducted

Put teeth (and funding) into monitoring, data collection, analysis, and enforcement