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by Matthew L. Israel

1971-1985: Beginnings, Philosophy and Early Growth

I studied psychology under the late B.F. Skinner as an undergraduate, as a graduate student, and as a post-doctoral fellow at Harvard University. I received a doctorate in psychology at Harvard in 1960. I was very impressed with Skinner’s work and accomplishments. As a result, I was confident that the basic behavioral principles and technologies that he had developed or refined could be fruitfully applied in the treatment of a wide variety of behavior disorders. Behavioral principles appeared to be extraordinarily successful in both explaining and managing behaviors.

My first opportunity after graduate school to apply these principles and techniques was in the 1960’s, during which time I founded a company in Cambridge, Massachusetts that wrote self-instructional materials for publishers and businesses and manufactured teaching machines. Another opportunity was in two behavioral communes that I started in 1966 and 1967. In one of these I employed behavioral principles to eliminate a three year old girl’s behavioral problems, changing her from what some considered to be extremely spoiled, demanding and annoying, into a charming presence in the house. In the late 1960’s I consulted to the Rhode Island Children’s Center where I developed a behavior modification program for neglected and dependent children in one of the homes at that Center. In 1970 the director of the Emma Pendleton Bradley Home for Children in Riverside, Rhode Island, invited me to establish its first unit for the treatment for autistic children.

In 1971 I started the Judge Rotenberg Educational Center (JRC) by offering behavioral treatment consultation in the homes of parents of autistic-like children. JRC’s first residential program was started in the fall of 1972, within a private home in Cranston, Rhode Island. The program at that time served two adolescent students. One was the schizophrenic child of the parents who lent us a wing of their home to use as the treatment center. From 1971 to 1994, the program was known as Behavior Research Institute. In 1994, we changed our name to the Judge Rotenberg Educational Center, to honor the memory of the judge (right) whose courageous decisions and actions (see below) helped to preserve our program from extinction at the hands of state licensing officials in the 1980’s.

From its inception in 1971 JRC’s basic plan was to apply, in a comprehensive and thoroughgoing manner, the then-newly emerging science and technologies of behavioral psychology to the education and treatment of severe behavior disorders. To use behaviorism as the foundation of treatment was a new approach to such treatment, which at that time was still heavily influenced by the use of pharmaceuticals and the psychoanalytical approach of Freud and his followers. A thoroughgoing and consistent behavioral approach to treatment was quite unusual at that time. The more common approaches at that time were psychoanalytic treatment, psychotropic drugs, normalization, educational approaches, milieu therapy, psychiatric counseling, play therapy, or eclectic, multidisciplinary approaches in which a combination of a little bit of several different approaches were used, with none predominating.

A thoroughgoing behavioral approach differs markedly from these traditional approaches in certain ways. Some of these differences, which are itemized below, have caused JRC to experience difficulties with licensing agencies from time to time.

• Near-zero rejection and expulsion policy. We have always accepted any and all individuals for treatment and have tried to maintain a zero or near-zero rejection and expulsion policy, provided that the needed treatment procedures are made available to us. We do not limit those whom we accept to persons with certain psychiatric diagnoses and labels. In fact, once we have determined that the least restrictive and most effective treatment for a student is behavioral treatment, we really pay relatively little attention to psychiatric diagnoses which are essentially labels for groups of behaviors. Instead, we look directly at the behaviors that are the individual’s problem and simply set about treating each of those individual behaviors. Of the first two students we worked with, one was labeled autistic and one was labeled schizophrenic.
  
  Our policy of near-zero rejection and expulsions, coupled with the success we demonstrated in treating our students, resulted in agencies referring their most difficult behavior problems to us. Most of our referrals had been unsuccessfully served in numerous other private and public mental health and educational facilities before they were referred to JRC.  Many of our students arrive directly from unsuccessful psychiatric admissions.
   

• Active treatment rather than warehousing. We do not solve behavioral problems by simply accepting the problem behavior as it is and adjusting our treatment environment to allow it to occur; instead, our goal is apply active treatment and educational procedures to change the behavior so that the individual can function successfully in the normal environment outside of our treatment facility.
  
  The fact that our mission is to provide active and relatively rapid treatment of severe behavior problems, with a no-rejection and no-expulsion policy, and not merely to serve as a care facility for children whose only problem is that they lack a normal home environment, explains some of the issues we have had with licensing agencies from time to time. Licensing standards that are set up for the latter type of facilities are not appropriate for programs that are designed for the active treatment of extreme problem behaviors.
   

• Treatment with a unitary, coordinated and comprehensively  Skinnerian, behavioral approach, rather than with a “multi-disciplinary” approach. The hallmark of JRC is that it is makes use of a behavioral approach and that this approach guides and informs all services provided by the agency to staff, students and parents. Although JRC has always employed nurses, speech therapists, physical therapists, psychiatrists, physicians, medical consultants and teachers, all of these special services are administered in a manner that is as consistent as is possible and practical with an overall Skinnerian, behavioral approach. JRC is probably the most consistently behavioral treatment program in existence.
   

• Behavioral rather than a psychiatric, approach. A behavioral approach essentially views a treatment problem as one in which the individual has certain behaviors that need to be decreased and certain ones that need to be increased. The fundamental technique for accomplishing these increases and decreases is the application of rewards and punishments. We use as one of our most important measures of effectiveness, the frequency of problem and desired behaviors. Behavioral frequencies and trends are displayed on Precision Teaching Charts that had been designed in the 1960s by Dr. Ogden Lindsley, another student of Skinner. Behavioral treatment decisions are based  on the data shown on these charts, rather than on clinical impressions, hunches, or observations alone.
   

• Behavioral, rather than traditional counseling. At JRC counseling is done as a fully coordinated and integrated component of a total behavioral approach. We call our counseling “behavioral counseling.” This means, for example, the following: the counseling is not given on a regular schedule but rather on an as-needed basis; the counseling is not given at points where it might function as an inadvertent reward for some problem behavior that has just occurred; the counseling is given by clinicians and other trained staff that are employed by JRC, rather than being provided by persons outside of JRC; the content of the counseling session is not necessarily kept private between the counselor and the counselee, but instead is shared with other professionals in the agency as needed; and the purpose of the counseling is to enhance the student’s cooperation with, and progress within, the JRC program and to change his/her behavior toward the treatment goals set by JRC.
   

• Behavioral procedures as the means of treatment, rather than the use of normalization. The dominant philosophy of the care of mentally disabled individuals during much of JRC’s existence, which continues even today, is that of normalization, also sometimes referred to as social role valorization. This approach, which insists that such persons should be placed in, and cared for, with as “normal” a set of procedures as possible, is frankly opposed to the notion of behavioral treatment. In behavioral treatment, normalization is accepted as the goal of the treatment process, but not as the means for reaching that goal. Indeed, behavioral procedures that will effectively eliminate problematic behaviors and help the student improve his/her condition and live a more normal life often have to be highly abnormal at first until the behavior changes sufficiently. As the behavior changes, however, the environmental conditions can and are made increasingly normal.
  
  In this respect, JRC is like a medical hospital. The goal of most medical hospitals is to return the individual to good health and to a normal living situation outside the hospital; however, in order to reach that goal it may be necessary to do some highly “abnormal” procedures within the operating rooms and in the emergency and intensive care wards of the hospital.
   

• A complete treatment facility—i.e., not tossing the treatment problem to others when the problem becomes difficult. We view our program as a “hospital of last resort” where whatever behavioral treatment is needed will be applied to solve the problem. If a student becomes difficult to handle, we do not turn the problem over to a psychiatric facility or to the criminal justice system; instead, we adjust our treatment procedures to adequately deal with the problem behaviorally.
   

• No or minimal use of psychotropic medication. We have always employed either no psychotropic medication at all, or the very minimal amount that is needed. Psychiatrists are employed to help us assess whether such medication is needed and to help us diminish or eliminate the psychotropic medication when it is not needed. Our psychiatrists make considerable use of our behavioral charts as they make these decisions.
   

• Use of powerful rewards. In order to treat individuals without drugs, and without traditional counseling or warehousing, a program will obviously need alternative effective procedures that can be used in their place. In JRC’s behavioral approach this means, among other things, that first and foremost the program must have available as powerful a set of rewards as is possible. The first area in JRC’s present school building that we created was a large arcade-type reward area to motivate students to behave well and learn. We also created a reward corner in each developmentally delayed classroom, reward boxes for the teachers to use, a contract store where students could pick rewards to purchase and work for, etc. We are not aware of any other treatment center that uses as wide a variety and as powerful a set of rewards as we do.
   

• Giving the parent the option to supplement the reward treatment with physical aversives when rewards and educational procedures alone prove to be insufficiently effective.   If treatment with the use of rewards, loss of privileges, fines, other non-physical aversives, and educational procedures, prove insufficiently effective by themselves, then the parent should be given the option of supplementing the student’s program with carefully administered physical aversives. In the 1970s and 1980’s, JRC employed physical aversives such as the pinch, spank, muscle squeeze, water spray, vapor spray (mixture of compressed air and water), ammonia capsule, unpleasant taste, and white noise. During the 1991-1993 period, JRC substituted a 2-second remote-controlled shock to the surface of the skin for all of these procedures. This procedure is called the GED (Graduated Electronic Decelerator).
  
  At the time that JRC was starting (1971), a movement to limit the use of punishments in the raising of children was already well under way. In that year, for example, Sweden passed a law banning the use of punishment with children. (Interestingly, no punishment was specified for failing to obey the law). The use of punishments in the education and treatment of children is still, today, vigorously opposed in certain quarters and has even been banned in the regulation of certain state agencies. OCCS regulations, for example, explicitly ban the use of aversive procedures. Every year or so a bill is introduced in the Massachusetts state legislature to ban the use of aversives. (This bill has never passed, however.) Because of all this, JRC and its parents have had to battle fiercely over the years to create and preserve this important component of its treatment.
   

• Video monitoring, 24/7 of staff performance. The best-laid behavioral programs in the world are to no avail if they are not carried out as designed by the direct care staff. Ever since JRC’s first residential program in 1975, we have used videos cameras in all rooms to monitor staff, and sometimes student, performance.

This set of policies has always enabled JRC to provide unusually effective treatment. Ultimately, the parents and placement agencies are interested in is just that—effective treatment. As a result, during the period 1971 through 1985 JRC grew from 2 students to approximately 65 students. Our school and administrative offices were in Providence, Rhode Island during this period.

From 1971 to 1975 JRC operated as a day school/treatment center. The program was approved by both the Rhode Island Department of Education and was licensed by the Rhode Island Department of Mental Health. In 1975 we opened a residence for some of its students in Seekonk, Massachusetts. In succeeding years we added other residences in Attleboro and Rehoboth, Massachusetts. These residences were licensed as group residences by the Massachusetts Office for Children (OFC).
 

1985-87 Failed Attempt by Office for Children to Close JRC

In 1985 a young man died at JRC while being restrained at one of our residences. The cause of death was ultimately determined to be natural causes related to his condition of tardive dyskinesia and not due to the restraint procedure that had been employed. Opponents of JRC seized on this death, however, to call for the closure of JRC. JRC’s opponents included officials of the National Society for Autistic Children and various other local advocacy groups, such as the Disabilities Law Center, Massachusetts Association for Retarded Citizens, Massachusetts Civil Liberties Association, etc. All of these agencies wrote letters to the Governor, urging him to close JRC. The governor of Massachusetts at that time was Michael Dukakis, who was preparing for his 1988 run for president[1].

In September 1985, the Massachusetts Office for Children (OFC)[2] issued an order to JRC to close its program and closed JRC’s ability to take in any additional students. JRC’s parents organized in support of the program and brought suit against both OFC and JRC to prevent the closure. JRC also appealed the closure and countersued OFC. The matter was heard by an administrative law judge of the Department of Administrative Law, who ruled that the program could remain open, but curtailed JRC’s aversive treatment procedures. This caused an immediate and serious regression in the behaviors of many of JRC’s students. Some showed intense, problematic and dangerous behaviors  and many staff members resigned due to the overwhelming task of managing intense behaviors without adequate treatment procedures. JRC appealed this decision of the Administrative Law judge to the courts and also fought numerous court battles with OFC over the legality of other actions that OFC took during that period.

While this litigation was taking place, in late 1985 and early 1986, JRC brought one of its seriously self-abusive, autistic students before the Bristol County Probate Court for a substituted judgment hearing that was held by Chief Judge Ernest Rotenberg. After hearing testimony on both sides of the issue, Judge Rotenberg determined: (1) that the student was incompetent to make her own medical treatment decisions; and (2) that the child, if competent, would have chosen treatment that included the use of the aversives that JRC had been employing, prior to the decision by the administrative judge. This substituted judgment hearing was the same type of hearing that was required in Massachusetts for individuals for whom agencies wished to employ psychotropic medication (or other intrusive medical procedures) and who were incompetent to make their own treatment decisions.

Armed with this determination, JRC resumed the use of aversives in this child’s treatment and the child, who had seriously regressed during the period when the aversives had been curtailed, recovered and resumed her treatment progress. JRC then began to bring each of the other students who needed aversives in his/her treatment before Judge Rotenberg for substituted judgment determinations.

When a proposal to employ aversives is examined in the context of an individual case, as is done in the substituted judgment proceedings, the matter always looks quite different from how it looks when aversives in general are discussed as a general philosophical matter. OFC objected, however, taking the position that Judge Rotenberg had no authority to permit the use of such aversives if OFC had banned their use.

At this point Judge Rotenberg was temporarily given the powers of a Superior Court judge, and all of the various legal battles that were ongoing between OFC and JRC (then known as the Behavior Research Institute, or BRI), and between the JRC parents and OFC, were consolidated in one legal action in front of Judge Rotenberg. At a critical point Judge Rotenberg enjoined OFC from taking any adverse licensing action against JRC and ruled that the further legal expenses of the parents and of JRC, which were now exceeding what either could bear, should be born by OFC. Judge Rotenberg also made findings that the OFC Director had been acting in bad faith in certain of her licensing actions. These included inviting a national panel to review JRC that she knew was biased against the use of aversives.  OFC, through its counsel the Massachusetts Attorney General’s Office, appealed Judge Rotenberg’s findings and orders to a Single Justice of the Massachusetts Appeals Court.  Judge Rotenberg was quickly affirmed.  

Shortly after that the parties (OFC, JRC Parents, and JRC) reached a settlement that was embodied in a Settlement Agreement in 1986 that Judge Rotenberg approved in early 1987 and adopted as an order of the Court. The most critical provisions of this Settlement Agreement are these:

1. JRC must be allowed to continue to employ aversives, but only if each student with whom it wished to employ aversives undergoes a substituted judgment hearing.
    

2. A Court Monitor was appointed to visit JRC periodically and to report to the Court on the status of JRC. John Daignault, Psy.D., was appointed to be the Court Monitor.
    

3. OFC agreed to issue a letter of apology to the JRC Parents.
    

4. The Commonwealth agreed to be bound by the standard of “good faith” in its licensing dealings with JRC.
    

5. A Mediator was appointed to hear disputes that might arise between JRC and its licensing agent. The purpose of this was to keep these disputes from burdening the court system. If the mediator is unable to solve the problem through mediation, any party is permitted to appeal directly to the Bristol Probate Court without having to go through the usual and time-consuming administrative law process. John Daignault, Psy.D., was appointed to be the Mediator.  He was succeeded by the Honorable John Hurd.  The Honorable Lawrence T. Perera has been appointed to assume the role of mediator when his appointment as Receiver has concluded.
    

6. In recognition of the bitterness that had developed between OFC and JRC, and to give JRC a fresh start, the licensing functions that OFC had exercised over JRC were transferred to DMH.  DMH soon thereafter spun off DMR as a separate state agency and DMR assumed DMH’s obligations under the Settlement Agreement.

During 1987, the attorney who had headed OFC during the OFC-JRC controversy was removed or transferred from that office and the agency was given a new head.

In 1987 DMH formally accepted its obligations under the Settlement Agreement. Later in 1987 or in 1988, DMH adopted new regulations on the use of aversives which paralleled its obligations under the Settlement Agreement. During the process of developing these regulations, DMH invited input and consultation from JRC. The new regulations categorized aversives into three levels and required that the most severe aversives (Level 3 Aversives) could only be employed if the petitioner obtained court authorization through the same substituted judgment process that JRC was required to use under the Settlement Agreement. The regulations also created a certification process in which certain organizations would be certified on a program wide basis to be allowed to employ Level 3 aversives. This certification must be renewed every two years.

In 1986 or 1987 some anti-aversives advocates introduced a bill in the Massachusetts legislature that would ban the use of aversive procedures. Although the bill would ban all aversive procedures, it was clear that it was aimed at JRC in particular. In 1987 the bill passed its initial committee and even passed the entire House of Representatives. Fortunately, because Michael Dukakis was running for president in 1988, the legislative session was abbreviated to help him spend more time on the campaign trail and the bill was not taken up by the Massachusetts Senate. The same bill has been introduced every few years since then and each time JRC staff, parents and students have lobbied vigorously to kept he bill from passing. Fortunately we have been increasingly successful in doing this each time the bill has been introduced.

In the late 80’s or early 90’s DMH spun off its mental retardation services as a separate agency known as the Department of Mental Retardation (DMR). After its creation, DMR adopted DMH’s regulations on the use of aversives, and sought and obtained from the court an amendment of the Settlement Agreement to add DMR as a party to that agreement.
 

1987-1993 Peace, Calm and Growth under DMR

From 1987 to 1993 JRC functioned very well under the new DMR licensing authorities and resumed its growth. JRC’s population, which had shrunk to about 39 students during the JRC/OFC controversy, rose to 65 by 1993. During these years we introduced a few new features to our program:

• Beautiful decoration. We have made it a point to make all of JRC’s spaces, in the school, in the administrative offices, and in the residences, unusually beautiful. No institutional furnishings are used and every bedroom and residences is decorated differently from every other. Our goal is to make the experience of attending school an attractive one, and to create a colorful, beautiful and optimistic learning environment.
  
  By making our school building as rewarding as possible, both in its look as well as in its various reward functions and areas, we have been able to use the opportunity to attend the school building as an earned reward. Similarly, students who behavior extremely poorly are required to stay in their residence and receive their academic instruction there, instead of at our school building.
   

• Maximum use of computer technology. As computers came into use, we saw them as an important tool. Every student has his own computer. There is now staff and student networks and web sites, discussion boards, an executive blog, a parent/agency web site, etc. Approximately 70% of our instruction is self-paced, programmed instruction that is carried out by means of self-instructional software. All behavior data is entered in a database and displayed through charting software that can be viewed from any computer on our network. We now monitor all classrooms residences and buses by means of digital video monitoring and recording.

In approximately 1992, DMR received a new Commissioner named Philip Campbell. Commissioner Campbell had previously been the head of the Massachusetts Association for Retarded Children (MARC). Mr. Campbell appears to have had a strong personal and philosophical opposition to the use of aversives and to the existence of JRC. While serving as the head of MARC, he had testified in favor a bill to ban the use of aversives in Massachusetts.

1993-1997: Failed Attempt by DMR to Close JRC

In 1993, Judge Ernest Rotenberg died. The Honorable Elizabeth LaStaiti succeeded him as Chief Judge of the Bristol County Probate Court. Shortly after that, DMR began a comprehensive campaign to close JRC and to interfere with JRC’s ability to obtain referrals from other states. The details of this campaign are to be found in a set of findings that Judge LaStaiti eventually made in 1995 and which may be found at here. In carrying out his campaign[3] against JRC, Commissioner Campbell failed to abide by the provisions of the 1987 Settlement Agreement. This included a failure to act in good faith and a failure to use the mediation process to settle his disputes with JRC.

Once again, the parents of the JRC students organized themselves and came to JRC’s defense by bringing suit against DMR. In 1995 the matter came to a head in a public court trial at the Bristol County Probate Court in front of Chief Judge LaStaiti. During the course of this trial, which lasted for three weeks, Dr. Daignault resigned his role as Mediator, but retained his role as Monitor.

The Settlement Agreement had been intended to avoid further court battles between JRC and its licensing agency. Because the Settlement Agreement had failed to accomplish this, the court now imposed an unusual remedy. The court placed DMR’s licensing actions with respect to JRC in receivership. Eventually, retired judge Lawrence Perera was appointed to serve as Receiver. Mr. Perera was also appointed to serve as the mediator under the Settlement Agreement after he has completed his duties as Receiver. DMR appealed Judge LaStaiti’s decision.

In 1996 JRC moved its administrative offices and school building from Providence, Rhode Island to Canton, Massachusetts. JRC’s educational program continued to be approved by the Massachusetts Department of Education.

In 1997, Judge LaStaiti’s decision in the lawsuit between JRC and DMR was considered by Massachusetts’ highest court. The Massachusetts Supreme Judicial Court supported Judge LaStaiti’s decision. Shortly after receiving a copy of the decision of the Court, Governor Weld asked for and received the resignation of Commissioner Campbell. Gerald Morrissey, who had been the Deputy DMR Commissioner at that time, was then appointed to be new DMR Commissioner.

1997-Date: Peace, Calm and Growth under the Receiver

From 1997 and continuing to this date, JRC experienced another period of calm in its relationship with its licensing agency (DMR), which was now overseen by the Receiver. In 1996 JRC had moved its administrative offices and school building from Providence, Rhode Island to Canton, Massachusetts. JRC’s educational program continued to be approved by the Massachusetts Department of Education which had already approved the program when it had been located in Rhode Island.

The receivership gave JRC a welcome protection from further attempts by licensing agencies to interfere with its treatment. As a result, the program thrived and grew in size.

JRC took advantage of the respite in litigation that the Receivership ensured by introducing a few new major features into its program:

• Nutrition/wellness initiative. In approximately 2002 we began to invite nationally known nutritional experts to speak to our students and staff and we made a study of contemporary nutritional science. This led us to change our menus toward a much healthier type of foods and to encourage our students and staff in the same direction.
   

• Transparency in our treatment decisions. In 2004, we opened up a Parent/Agency website and began to place every possible document relating to our treatment decisions and the progress of our students on that site. Parents and placement agency officials can now, for example, keep up with the daily behavior charts, and even see the weekly progress notes that clinicians have entered for the student in question.

In 1997, JRC opened a 6-bed respite services program that provides short-term (30-60 day) respite services to developmentally disabled clients of the Massachusetts Department of Mental Retardation.

In approximately 2002, JRC opened its day program, called Tomorrow. Currently this programs serves 3 students.

Beginning in approximately 2003, the Receiver began to return various functions to DMR and to wind down the Receivership. DMR indicated its desire to transfer the licensing of students under the age of 22 back to OFC, which was now called OCCS. JRC agreed, but only on condition that JRC’s treatment modalities be preserved and that OCCS be willing to accept the obligations of the Settlement Agreement that DMR had been subject to. OCCS was reluctant to accept this obligation.

The matter was resolved on September 4, 2003 at a meeting of the parties in front of Steve Hanna, the First Assistant Register of the Bristol County Probate Court. The parties agreed that DMR would delegate its licensing authority over JRC’s under-22 population to OCCS. This means that  OCCS is acting as DMR’ agent in licensing JRC and that DMR and its agent OCCS must comply with all the terms of the Settlement Agreement. Judge LaStaiti issued an order effectuating this agreement.

As of June 30, 2005, OCCS ceased its existence as an agency under the Executive Office of Human Services (EOHHS). The licensing functions of OCCS have been transferred by statute to EOHHS. We are informed that as part of an interagency agreement, the Department of Early Education and Care (EEC), a new agency that started on July 1, 2005, has accepted all of the former OCCS licensing powers and obligations that had been transferred by statute to EOHHS, including EOHHS’ obligations to license JRC’s under-22 group homes acting as DMR’s agent.

Current Status

JRC’s educational program continues to be approved by the Massachusetts Department of Education. At the present time all of JRC’s residences are currently licensed by the Massachusetts Department of Mental Retardation (DMR). Currently, JRC is working with DMR and the licensing officials of the former Office of Child Care Services (OCCS) to try to separate out the under 22-years-old population of students at JRC and to have the residences that house those students licensed by EEC, the new agency that has taken over the licensing duties previously carried out by OCCS.

Today, JRC serves over 230 students and adults from many states. These individuals live in 37 apartments, town houses and homes which JRC operates in Canton and neighboring communities. All attend JRC's day school at its Canton facility each day. The program is staffed with approximately 900 employees.