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The Judge Rotenberg
Educational Center, Inc. (“JRC”) is a non-profit school located in Canton,
Massachusetts that provides special education services to children and
adults with life-threatening behavior disorders. JRC often acts as a
treatment of last resort for children and adults with severe behavior
disorders who have been resistant to all forms of drugs and other
psychiatric treatment and for whom there is no other placement that can
educate them and keep them safe. These students engage in behaviors such
as head-banging, eye-gouging, and biting off body parts. JRC’s policy is
to use a highly consistent application of behavior modification treatment
and minimal or no psychotropic medication. JRC offers intensive behavioral
treatment based on peer-reviewed and accepted methods of behavioral
psychology, which has been extremely effective and life-saving for
students who could not be effectively treated with psychotropic medication
or psychotherapy. JRC’s treatment procedures are so effective that they
rapidly reduce to a zero or near zero level the major problem behaviors of
students with the most difficult-to-treat behavior disorders in the
country.
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JRC provides a
community based behavioral program where students receive 24 hour
intensive behavioral treatment. Positive reinforcement and non-intrusive
procedures, such as point/token reward systems involving behavioral
contracts, are tried first to treat the problematic behaviors. In some
cases, a student for whom a positive-only behavioral treatment program is
not successful will continue to engage in aggressive and health-dangerous
behaviors and remain a danger to themselves and others. JRC will then
consider supplementing the student’s treatment plan with “aversive”
behavior modification techniques.
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The
aversives employed at JRC are safe, effective, and professionally approved
by a Peer Review Committee and Human Rights Committee under procedures
outlined by the Massachusetts Department of Mental Retardation (“MA DMR”).
See 115 CMR 5.14. They are used pursuant to regulations of the MA DMR and
the Massachusetts Department of Early Education and Care (“MA EEC”). JRC
does not use aversive techniques until a Massachusetts Probate Court
approves their use on an individual basis. JRC follows the MA DMR
regulations requiring these treatment techniques to be used in a safe,
well-documented manner. 115 CMR 5.14. JRC creates for each student a
written behavior modification plan detailing the treatment’s rationale,
duration, conditions, goals, and a detailed monitoring plan. 115 CMR
5.14(4)(c). A parent must sign a detailed aversive therapy consent form
before JRC will incorporate such techniques in a student’s treatment plan
and the aversive treatment is included and made part of the student’s
Individualized Education Plan or Individualized Service Plan.
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The most commonly used
“aversive” procedure at JRC is an electrical stimulation device
manufactured by JRC called the Graduated
Electronic Decelerator (“GED”). The GED unit consists of a transmitter
operated by a JRC staff member and a receiver and stimulator worn by the
student. The receiver delivers a low-level surface application of
electrical current to a small area of the student’s skin upon command from
the transmitter, as part of a designed behavioral treatment. There are no
harmful side effects and minor side effects may consist of reddening of
the skin and, on rare occasions, the appearance of a small blister, both
of which are temporary. For many individuals, the GED is required only
during the first few months of treatment, and is no longer necessary, or
is necessary to a far lesser and diminishing degree, after that period.
The students receive only one application per week on average. The Supreme
Judicial Court of Massachusetts has affirmed a Probate Court order
authorizing the use of the GED at JRC as an appropriate intervention. See
Guardianship of Brandon Sanchez, 424 Mass. 482 (1997); see also JRC
v. DMR, 424 Mass. 430 (1997). Over one hundred peer-reviewed articles
have been published in the professional literature supporting the safety
and effectiveness of skin-shock and eight articles deal with the specific
device (“SIBIS”) which is the forerunner of JRC’s GED device.
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The JRC staff are all highly trained, devoted
professionals who risk serious injuries to themselves to provide
critical treatment to the JRC students, who are the most difficult to
treat in the country. An important part of JRC’s treatment program is
teaching the student to cope successfully with events that normally
trigger problem behaviors. Students at JRC are assigned to highly
qualified clinicians who supervise the student’s treatment team
and are responsible for overseeing all aspects of the student’s treatment
program.
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JRC’s extremely
effective and therapeutic environment provides students an opportunity to
not engage in aggressive and self-injurious behaviors, and instead allows
them to better themselves through education and socialization. Many of
JRC’s students arrive directly from psychiatric hospitals, correctional
facilities or from other residential programs where they could no longer
be safely maintained and were being managed with heavy dosages of
medication along with seclusion and restraint. JRC’s treatment approach
has allowed individuals with severe behavior disorders and developmental
disabilities, who often had lived in constant physical and drug-induced
confinement, to be educated and learn skills in an atmosphere of minimal
restraint. JRC eliminates the need for restraint, even for students with a
life-long history of manual, chemical and mechanical restraints. JRC’s
treatment program has afforded students the opportunity to enjoy
activities in the community and most importantly, the opportunity to bond
and spend time with their family. Many of JRC’s students have graduated
and gone on to productive jobs in the community, further education, and
even service to their country in the Armed Forces. When students who have
had the GED in their treatment programs graduate from JRC, their success
in life-adjustment (jobs, school, constructive activities) is 83%.
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Students at JRC are
taught to make use of the local community for recreation, shopping,
laundry and other purposes. As a reward, many students may choose to swim,
play tennis or play basketball within the community. Rewards also include
the ability to participate in community outings to stores, movie theaters
and restaurants.
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While JRC’s treatment
is controversial, the treatment is vehemently supported by the parents of
the JRC’s students and by the JRC’s students themselves, many of whom have
testified in court and before state legislators about the success of their
treatment at JRC and their happiness to be removed from their former lives
of restraint, seclusion, psychiatric hospital admissions, and the sedative
effects of heavy dosages of antipsychotic medication.
It is important to distinguish JRC’s use of behavioral skin shock,
which is behavioral procedure used to punish problem behavior, from
electroconvulsive shock therapy (ECT) which is a psychiatric
procedure in which a current is passed through the brain to cause a
seizure in the treatment of depression or other psychiatric ailments. |