The Massachusetts Department of Developmental Services has proposed amendments to regulations regarding the use of aversive interventions. The amendments aim to establish professional standards for use of behavior modification procedures for persons with intellectual disability in public or private facilities. Specifically, the proposed amendments will:
Prohibit the use of aversive (Level III) behavioral interventions on a prospective basis; and,
Continue use of Level III interventions for individuals who, as of September 1, 2011, have an existing court-approved behavior plan that includes Level III interventions, and will allow their renewal each year so long as Level III interventions remain a part of their court-approved behavior plan.
Along with recent public hearings, the Department is accepting written comments to the Office of the General Counsel on the proposed amendments. The following letter from TASH has been submitted to the Department. In it, TASH applauds the Department for taking a step forward in its protection of children and youth with disabilities; however, TASH urges the Department to extend these protections to all individuals within the Commonwealth of Massachusetts.
July 26, 2011
Office of the General Counsel
Department of Developmental Services
500 Harrison Avenue
Boston, MA 02118
The following position statement is submitted to the Office of the General Counsel in the Department of Developmental Services for the Commonwealth of Massachusetts. It is regarding a proposed amendment of regulations on professional standards for behavior modification procedures for persons with intellectual disability.
TASH is a national grassroots leader in advancing inclusion and human rights of individuals with significant disabilities through research, education and advocacy. For more than 35 years, TASH has been a tireless advocate for people with the most significant disabilities and support needs – those most vulnerable to segregation, abuse, neglect and institutionalization. TASH is the founding member of the Alliance to Prevent Restraint, Aversive Interventions and Seclusion, a 22-member coalition of national disability organizations that seeks the elimination of aversive interventions used to control the behavior of children and youth and to ensure they enjoy equal rights and protections across all settings in which they receive mental health services and other services.
TASH would like to applaud the Massachusetts Department of Developmental Services in its effort to limit the use of aversive procedures on individuals with disabilities. The proposed amendments to regulations are a necessary step forward in the protection of students with disabilities by prohibiting the use of aversive procedures to modify student behavior. TASH encourages the Department to adopt these proposed regulations.
It is our hope that the Department will further consider expanding the elimination of aversive procedures to those students with existing court-approved behavior plans that include Level III interventions. It is our position that aversive interventions, such as the shock therapy applied at the Judge Rotenberg Center, have no place in mental health services. Individuals with disabilities have a right to behavioral treatment that is humane and proven effective.
TASH has adopted the following resolution opposing the use of aversive and restrictive procedures:
Throughout the world, individuals with disabilities are victim to the use of procedures that are aversive, coercive and/or restrictive to control behaviors that are associated with their disabilities. Aversive procedures use painful stimuli in response to behaviors that are deemed unacceptable by their caregivers. All aversive techniques have in common the application of physically or emotionally painful stimuli. Coercive and restrictive procedures use unnecessary amounts of control and manipulation in an effort to modify behavior.
These techniques are inappropriately used, not only to control dangerous behaviors, but also to modify behaviors that are simply idiosyncratic (e.g., moaning or twisting one’s hair), unusual (e.g., tics or rocking) or are inconvenient to caregivers (e.g., getting out of one’s assigned seat or refusing to perform a task).
TASH acknowledges the following rationale for its resolution opposing the use of aversive and restrictive procedures:
Individuals with disabilities who act in ways that are dangerous deserve at least the same protections afforded to prisoners against cruel and unusual punishment. Additionally, they have a right to treatment that is both humane and effective.
Treatment is meant to reduce or prevent further occurrence of a dangerous or disruptive behavior by increasing the individual’s competence to deal with the circumstances that provoke the endangering behavior. When an individual is at imminent risk of hurting him/herself or others, brief physical restraint to prevent injury may be necessary. Brief physical restraint under these circumstances is not treatment. It is used to assure safety in an urgent situation.
Aversive and restrictive procedures, including the inappropriate use of restraint, are often used as part of a systematic program for decreasing certain behaviors. They are most often used without the individual’s or even a substitute individual’s informed consent.
Although it has been believed that such procedures are necessary to control dangerous or disruptive behaviors, it has now been irrefutably proven that a wide range of methods are available that are not only more effective in managing dangerous or disruptive behaviors, but do not inflict pain on, humiliate, dehumanize or overly control or manipulate individuals with disabilities.
Alternative approaches that are proven to be effective attempt to identify the individual’s purposes in behaving as he or she does and offer support and education to replace dangerous or disruptive behaviors with alternative behaviors that are positive and will achieve the individual’s needs.
Therefore, TASH affirms the right of all persons with disabilities to freedom from overly restrictive procedures and from aversive or coercive procedures of any kind. TASH is unequivocally opposed to the inappropriate use of restraint and to the use of overly restrictive and aversive procedures under any circumstances and calls for the cessation of the use of all such procedures.