Residential Program Treating Behavior Disorders and Developmental Disabilities

CONTENTS OF THIS SECTION

JRC's Policy on Psychotropic Medication

We try to eliminate or minimize the use of psychotropic medication; however, we do employ it, as an additional component of the student’s total treatment program, when objective behavior data shows that it is needed to maximize treatment effectiveness. JRC is designed and staffed to provide a highly structured, intensive behavioral treatment program for severe behavior disorders. JRC has found that properly designed behavioral treatment is the most effective treatment available for behavior disorders in most cases. The treatment carries no risk of serious side effects. JRC's behavioral treatment is often a more effective and safer alternative to treating behavior disorders with psychotropic medications. The use of psychotropic medication has many problems, including these: the serious and disabling physical side effects, such as permanent damage to the nervous system; impairment of cognitive functioning which can diminish learning ability; lack of reliable evidence of psychotropic medications’ effectiveness in treating behavior disorders; and psychotropic medication’s inability to be targeted at specific behaviors. Although JRC is capable of implementing psychotropic drug treatment programs, and does so for a small number of clients under certain conditions, parents seeking such treatment for their child should consider other placements that specialize in that form of treatment.

JRC’s Basic Policy Regarding Psychotropic Medication

JRC specializes in providing a highly structured behavior modification treatment program combined with behavioral counseling and a behavioral education program. This approach has proven to be extremely effective in treating a wide range of behavioral problems. In providing this treatment, it is JRC’s policy to avoid, or at least minimize the use of psychotropic medication. Although JRC has the ability to administer psychotropic drugs as part of its treatment, has done so in the past and continues to do so at present with a few of its students, the major thrust of JRC’s treatment approach is to accomplish the needed changes in its students without resort to psychotropic medication. This enables JRC to avoid the undesirable and sometimes permanently disabling effects of psychotropic medication.

Treatment with psychotropic drugs is available in many other programs that provide such medication as an integral part of their treatment. Parents who strongly believe that their child requires the use of psychotropic medication and who are not interested in trying an approach, which avoids or minimizes such medication, are encouraged to consider enrolling their child in such programs rather than in JRC.

Students who are receiving psychotropic medication when they are enrolled in JRC will be seen by a psychiatrist after their enrollment for purposes of planning a program of medication reduction. Parents of JRC students, as well as the students themselves, are usually very pleased with the results that we area able to achieve with a non-drug, behavioral approach.

JRC admits students whose parents are seeking effective behavioral treatment. Sometimes these are students who have received no benefit from prior drug treatments and may have suffered adverse side effects from such drugs. We consider the use of psychotropic medication only after we are satisfied that behavioral procedures alone have proven to be insufficiently effective. We reach this point only after behavioral procedures alone have been given a thorough trial.

Currently there are some students at JRC who have reached this point and are receiving psychotropic medication as part of their treatment program under the direction of a psychiatrist. We may also use psychotropic medications when they are recommended by one of our consulting psychiatrists as a needed emergency measure. Prospective parents should understand, however, that these cases in which psychotropic medication is used at JRC tend to be the exceptions rather than the rule.

Our policy concerning psychotropic medication policy does not apply to cases of students who suffer from medical problems which require drug treatment or neuroleptic seizures.

Problems with the Use of Psychotropic Medication

JRC’s reasons for avoiding and minimizing the use of psychotropic medication whenever possible are these:

Psychotropic medications have often proved to have negative, and sometimes even poisonous, side effects that may not be recognized until years after the drug was first introduced to general use. Some psychotropic medications have proven to have extremely detrimental effects on the nervous system that are irreversible. By contrast, the behavioral procedures employed by JRC appear to have no significant side effects.
There is some evidence that psychotropic medication may interfere with a behavioral program by making behavioral procedures less effective than they otherwise might be.
The available evidence for the effectiveness of psychotropic medication is often based largely on case studies in which careful experimental controls have not been used. It requires a relatively difficult and time consuming experimental process to make sure that psychotropic medication is effective. To be certain that a drug is effective in treating a behavioral problem the following should be done:

The psychiatric problem should be defined in terms of the frequency of certain problematic behaviors. Objective data should be collected continuously on these behaviors before during and after the use of the medication;
One should learn enough about the normal variability of these behaviors, during a period when the medication in question is not given, in order to be sure that any apparent improvement that the drug produces is not due to this normal variability;
When the drug is introduced, the dosage should be adequate and must be ingested by, or otherwise introduced into, the individual;
Ideally, the individual’s caretakers, and those who are conducting the study, should be unaware of the date when the drug is introduced or removed. (The study should be "blind.")
During the period of time when the medication is being tried as a treatment, other educational and treatment procedures should be held constant;
If improvement is seen when the drug is introduced, the drug should then be removed at a later point to see if the improvement will stay in place without the medication; and
The individual should be followed up periodically by a trained clinician.

Because such procedures are not followed in many of the reported studies on the effects of psychotropic medication, such studies are not entirely reliable as a basis for making treatment decisions. By contrast, the effectiveness of behavioral treatment procedures tends to be very carefully researched in controlled scientific studies.

Carefully controlled evaluations of drugs are rarely if ever used to determine if a psychotropic medication, once it has been prescribed, needs to be continued. As a result, students in other programs are sometimes placed on psychotropic medications and allowed to remain on them for long periods of time without clear evidence either that they were necessary in the first place or that they continue to be necessary. By contrast, the effects of behavioral interventions can generally be seen quickly and objectively within an environment such as JRC that measures behavior on a daily basis.
Psychotropic medications are not able to be focused on a single behavior. Sometimes such medications affect the entire repertoire of the individual. By contrast, behavioral procedures can be precisely focused on a single behavior.

What this Means for Parents Applying for Admission to JRC

Because of these problems with the use of psychotropic medication, parents should understand that JRC employs its non-drug, behavioral treatment, education and counseling program to treat psychological problems that in other programs might be treated with psychotropic medication. Examples are psychosis, depression, anxiety, conduct disorder, suicidal tendencies and other psychiatric symptoms when our consulting psychiatrist has determined that our behavioral treatment is the least restrictive and most effective treatment for the student.
If a parent seeking admission to JRC wishes his/her child to continue with the use of any psychotropic medication or if the parent wants his/her child to be treated with a combination of behavior modification and psychotropic medication, our staff would have to consult most carefully with such a parent before accepting the child into the JRC program because the child may be more suitable for another program . . .
If, after a child enters JRC, his/her parents change their mind and decide that they want psychotropic medication used with their child, JRC may be unable to provide those services other than on a short-term transitional basis. This short-term use assumes that JRC’s medical and clinical services staff concurs that drug treatment can be safely implemented. In such cases, JRC will also initiate an IEP meeting and ask the placement agency to find an alternative placement where the child will be able to receive the treatment that the parent now wishes.
Students receiving psychotropic medication at the time of admission to JRC, will be removed from such medication after they are enrolled in JRC, in accordance with a schedule determined by our psychiatrist and agreed to by the parents.

Situations in Which Psychotropic Medication Might be Used at JRC

The only cases in which psychotropic medication is used at JRC are those that fit one or more of the descriptions listed below. Currently (as of January 2000) only 7 out of 115 of our students are receiving any psychotropic medication:

We have exhausted our behavior modification treatment procedures and believe we can make little further progress on one or more behavior problems without trying the addition of psychotropic medication. In these cases we may add psychotropic medication as a supplement to the ongoing behavioral treatment. If the student improves when this is done, we will also take steps to evaluate whether the medication has been a critical component of that improvement. This will be done, with the permission of the parents and under the supervision of a psychiatrist, by removing the medication for a certain period of time and determining whether improvement continues even after the medication has been removed.
The student has displayed an extremely dangerous, life-threatening behavior (e.g. serious suicidal action) and a psychiatrist has recommended that his/her treatment should include some psychotropic medication. Again, if the student does well while under the medication, we will, at some later date, evaluate whether the medication needs to be continued. If it is not, the medication will be discontinued.
The student is awaiting a transfer to some other program, the parents desire psychotropic medication to be used until the transfer is effected, the JRC medical and psychological staff concur that drug treatment can be safely implemented and JRC has the necessary legal authority to administer the medication.
A judge has ordered that psychotropic medication be maintained.
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