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A Description of the Treatment and Education Programs at JRC

The Judge Rotenberg Educational Center (“JRC”) is a non-profit residential school located in Canton, Massachusetts that provides special education services to children and adults many of whom have life-threatening behavior disorders. JRC’s program is based on three basic principles:

• Near-zero rejection policy: JRC accepts persons with severe, case-hardened problem behaviors that tend to be rejected by other programs. JRC’s treatment and education program often acts as a placement of last resort for children and adults with severe behavior disorders who have been resistant to all other forms of psychological and psychiatric treatment and for whom there is no other placement that can educate them and keep them safe.

• No or minimal psychotropic medication. JRC minimizes the use of psychotropic medication, to avoid the unfortunate known and sometimes as-yet-undiscovered side effects that such medication often has.

• Use of highly consistent application of behavior modification procedures both in the education/treatment of its students and in the management of its staff. 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, psychotherapy or positive only behavioral programming.

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.  The treatment has afforded students the opportunity to enjoy activities in the community and, most importantly, the opportunity to bond and spend time with their family.

Positive reinforcement and non-intrusive procedures are tried first to determine if they can be sufficiently effective. JRC’s experience is that positive procedures alone prove to be sufficiently effective with 51% of its incoming students; if not, JRC considers supplementing them with professionally approved  “aversive” behavior modification techniques such as a brief shock to the surface of the skin[1]. Such aversive techniques are added to the treatment plan only with the prior signed, written consent of the parent/guardian as well as the prior court approval. 

The remainder of this document describes the key features of JRC’s unique and highly effective treatment and education programs.  For more in-depth information please go to the Key Features section of this web site.

1. Intake of New Students into JRC’s Unique Intensive Behavioral Program
   Many of JRC’s new students arrive directly from psychiatric hospitals or from other residential programs where the student could no longer be safely maintained and were being managed with heavy dosages of medication along with seclusion and restraint.  JRC’s first priority upon intake is to safely manage the student’s self-abusive and aggressive behaviors and address all urgent medical needs.  For instance, new JRC students are often suffering serious side-effects from their medication which requires JRC to develop an immediate medical plan to treat these side-effects and stave off serious permanent injury and begin lowering the medication dosages.  JRC employs eleven nurses who provide round the clock care.  JRC has three consulting physicians and three consulting psychiatrists who are always available by phone and who are often present at JRC providing care and medical monitoring.  JRC also has consulting relationships with a wide range of specialists who practice at Boston area hospitals.

   1. JRC’s Highly Trained Staff
      To keep the students safe from their severe self-abuse and aggressive behavior, JRC employs over 950 highly trained, direct-care staff.  They provide 24-hour staffing for JRC’s two school buildings in Canton, MA and JRC’s forty eight group homes which are located within eight towns in southeastern Massachusetts.  JRC staff must pass a rigorous two week pre-service training course which graduates only 80% of the candidates that enter it.  The training requires the candidates to learn and demonstrate a proficiency in all the skills required to maintain the students’ safety, including physical and mechanical restraint, first aid, CPR and how to implement a 24-hour intensive behavioral treatment program.  Yearly, mandatory in-service training at a minimum of thirty hours requires the staff to maintain their proficiency and keep up with advances in the field.
      
      The direct-care staff members are also trained to operate JRC’s fleet of vans, which are used to transport the students each day to and from their group homes for school, fieldtrips and medical appointments.  JRC’s buses are customized to maintain safety during transport and to respond to violent outbursts of behavior that does occur especially with the newer students.  The vans are also monitored using DVR technology.
      
      JRC conducts bi-weekly written performance evaluations of all direct-care staff and conducts constant and intensive quality control which includes a written assessment and numerical evaluation after each shift.  JRC monitors staff through a heavy deployment of 35 quality control supervisors throughout the school and residences along with DVR (Digital Video Recording) cameras in every classroom and student related areas of the school buildings and in all rooms at the group homes. Banks of live DVR monitors are watched 24-hours per day and video footage is spot-checked by special “DVR monitoring” staff.  Each staff member not performing his or her duties correctly is given immediate verbal feedback and receives immediate disciplinary or other appropriate remedial action, such as retraining, to promote proper performance at all times.
      
      This DVR technology is also used by all of our clinicians and high level administrators to monitor staff and student performance as well. To insure that students programs are being carried out correctly, clinicians spend a portion of each day in the classrooms, directly observing how staff are implementing their students’ programs in the classroom. In addition, JRC’s case managers have their desks right in the classroom to help to monitor student programs and staff performance.
       

   2. JRC’s Positive-Only Programming
      New students undergo a thorough analysis which starts long before the student is admitted for treatment. In some cases members of JRC’s admissions staff may visit the parent/child in the home or alternate school/hospital setting prior to the child’s arrival at JRC. JRC’s admission staff, psychology staff and medical staff review the student’s treatment and medical history in order to identify all the dangerous and other problematic behaviors the student exhibits, all prior treatments, and all health issues.  A plan is then developed to meet all of the students need on the day of admission.

      1. Establishing Rewards
         JRC staff conducts an in-depth interview of student and the parents in order to obtain additional and the most recent information on these issues and to discover the rewards that would most interest the student.  JRC then establishes a set of rewards that the student will want to earn.  At the heart of any successful behavior modification system is a set of rewards that the student will want to earn.  Some of the most prominent at JRC are as follows: 

         1. Classroom Reward store or Residence Reward area (an area in the classroom and at the group homes which contains comfortable furniture and leisure activities, such as televisions, stereos, personal electronics, art supplies, games, and age-appropriate toys)

         2. Big reward store (an arcade stocked with carnival type food and beverages, and loaded with fun activities for all ages such as video games, flat screen TVs, pool table, massage chairs, music, pin ball machines, and internet kiosks)

         3. Contract store (which contains items available for purchase with points earned for good behavior, such as popular clothing, bath products, video games and systems, CDs, DVDs, CD players, MP3 players, sunglasses, and caps)

         4. Weekly Afternoon Barbecue/Field Day (JRC hires caterers and outside entertainment vendors to turn its outdoor campus into a festive block party every Thursday and invites students to join the party by earning enough points for good behavior)

         5. Field trips (to all available community activities such as amusement parks, beaches, sporting events, museums, zoos, malls, and any other activity suggested by the students or their families)

         6. Basketball. (field trips for students to go to a local gym are available five days a week)

         7. Dances

         8. Internet usage

         9. Money to purchase a favorite item or activity in the community

         10. Trips to a favorite restaurant with favorite classmates and favorite staff

         11. Student Chat Room software developed by JRC enables students to communicate/socialize with other students around the school
              

      2. Identifying Problem Behaviors
         JRC analyzes the student's problems in terms of sets of behaviors that need to be increased or decreased in frequency.  JRC categorizes problematic behaviors as belonging to one of seven broad categories:

         1. Health Dangerous (includes self-abusive actions such as hitting self)

         2. Aggressive

         3. Destroying

         4. Noncompliance

         5. Major Disruptive Behaviors

         6. Educationally and Socially-Interfering Behaviors

         7. Inappropriate Verbal Behaviors

         If a particular student needs more than these seven standard categories, additional categories are created. And if a clinician wishes to divide one of these categories into smaller sub-categories, he/she may do this.
          

      3. Establishing a Point/Token Reward System
         JRC sets up a point/token reward system.  These are systems where points or tokens can be earned by the display of target behaviors and the points or tokens can be spent to purchase rewards.
         
         JRC creates a system of behavioral contracts.  Contracts are arrangements in which, if the student goes for a pre-set period of time without displaying certain specified problem behaviors, he or she earns a specified reward at the end of the contract period.  The pre-set period of time could, depending on the student’s intellectual functioning level and behavioral status, be as short as 30 seconds or as long as a week or more.  The contract is designed so as to make passing successfully easily achievable. The length of the contract and the value of the reward are increased as the student’s behavior improves.  If, however, the student exhibits the specified problem behavior(s) during the period covered by the contract, then the contract is considered to be "broken," a new contract is set up, and the student tries again. There are many types of contracts that are used at JRC.  Typically, students will have several different contracts (that run for different amounts of time and that entail different rewards) running simultaneously.
         
         As the student’s external behaviors improve, internal behaviors, such as the student's thoughts, feelings, urges and emotions, tend to show an automatic improvement.  For example, as the student begins to pass behavioral contracts, succeed in his/her academic work, etc., he/she feels better and his/her self-concept, self-esteem and confidence improves.
         
         JRC records and charts the daily frequencies of the student’s targeted behavior categories 24 hours each day, seven days a week.  Click here for a description of JRC’s charting system.
          

      4. Reducing/Discontinuing the Student’s Reliance on Psychotropic Medication(s)
         JRC will also attempt to minimize the use of psychotropic medication(s).  If a student is on medication when he or she enrolls at JRC, the medication may be removed under the guidance of a psychiatrist.  Psychotropic medication is employed only if the charted behavior data and observations of the student support the need to use it as an adjunct to JRC's behavioral treatment program. Please click here for a description of JRC’s efforts to reduce a student’s reliance on psychotropic medications.
          

      5. Clinicians Oversight of the Student’s Treatment Program
         An important part of JRC’s treatment program is teaching the student to cope successfully with events that normally trigger problem behaviors.  It is important to identify those stimuli and events that normally trigger the occurrence of the student's problem behaviors.  These are presented to the student on planned occasions; the student is taught how to cope with these successfully; and he/she is rewarded when he does so.
         
         JRC employs 13 full-time staff clinicians and 2 part-time clinicians, all of whom are assigned specific students for their case load. Twelve of the fifteen clinicians have a doctoral degree. The assigned clinician supervises the treatment team assigned to the student (consisting of the assigned clinician, program designer, case manager, nurse, psychiatrist and teacher) and he/she is held responsible for making all needed treatment adjustments. The clinician must continually modify the positive only treatment program to further decrease targeted behaviors.  The clinician is responsible for reviewing the charts on a regular basis, meeting with the student from time to time, observing the classrooms daily, entering progress notes and writing progress reports, and making changes in all interventions until the treatment program is working with sufficient effectiveness.  Every week a clinician must present the charts of all of his or her students at a chart sharing session attended by all of the other clinicians, case managers, top administrators and the executive director.  The group makes suggestions for improving the treatment and becomes immediately aware of any case where a student is not progressing satisfactorily.  In effect, through these sessions, the group holds the clinician responsible for producing progress in all of the students under his or her care.
          

2.  JRC’s Educational/Vocational Programming
   JRC serves both higher functioning students who are cognitively intact as well as lower functioning students.
   
   JRC employs several behaviorally-based educational technologies as explained below:

   1. Programmed Instruction with JRC’s Innovative Software
      JRC uses “programmed instruction,” through computers and JRC’s staff of 20 teachers, as the method for designing JRC’s education and instructional program. JRC has developed its own software that  involves carefully analyzing and sequencing materials to be taught so as to minimize errors and provide immediate feedback to the learner on each instructional step. This maximizes both learning and self-confidence. Instruction is individualized so that each student may learn at his or her own optimal rate. The educational and instructional materials are presented through software on a personal computer under the supervision of a certified teacher. The key features of this instruction are these:

      1. The selected subject matter is based on the student’s current grade-level and the student’s special education needs.

      2. Self-paced instruction. The student studies and learns at his/her own pace.

      3. Immediate feedback on each learning trial. The student learns immediately, as he/she enters each answer, if he/she is right or wrong and can study the correct answer immediately.

      4. Behaviorally designed sequencing of component skills. All competencies are analyzed and broken down into a carefully sequenced series of skills, each of which builds upon the skills learned up to that point.

      5. Prompting techniques are built into the majority of the software to help the student answer correctly and to minimize errors.

      6. Student-competency is measured at the completion of each chapter.

      7. Chapter mastery is measured by rates correct/incorrect instead of percent correct.

      8. Automatic rewards may be arranged for chapter mastery, sometimes with computer games.

      9. Built-in Review of previously mastered skills. New chapters both present new material and also review previously-taught skills.

      10. Graphical display of goals and achievement. Some software packages display the student’s rates correct and incorrect on a graph at the end of each pass through a chapter of material.

      11. Mastery of each skill required before advancement. The student is required to master each skill at a certain target level (at or above a pre-designated rate correct and at or below a pre-designated rate incorrect) before he or she is allowed to advance to the next skill in the series.

      12. Integration with behavioral treatment program. The overall behavior modification program, including the point reward/fine system, is employed to motivate the student to learn and make progress.

      Much of the instructional program at JRC is carried out through self-instructional materials that employ these principles and that are presented by means of networked computers under teacher supervision. The computers deposit student performance data in files that are accessible from the teachers’ and administrators’ computers. This enables a teacher or administrator to monitor progress on a daily basis.
       

   2. Precision Teaching
      Precision Teaching is technology for measuring and charting learning in terms of rates correct and incorrect. The essence of Precision Teaching is to measure the rates (i.e., the frequencies) of correct and incorrect responses, for all academic and other skills being taught, to plot these rates on charts so that the levels and trends can be seen immediately and to take appropriate corrective or other action based on the charted data. Rates of correct and incorrect responses are a more sensitive measure of progress than the traditional measure of percent correct.  These charts enable the teacher to monitor the student’s progress daily and enable the teacher’s supervisors to evaluate the effectiveness of the teacher’s work. They also enable the students to see and evaluate their own progress, day by day.
      
      JRC’s own networking software enables all teachers, case managers, program designers, administrators and clinicians to view these charts, which are the central means that JRC uses to measure the students’ progress. The charts are updated daily. JRC’s Parent/Agency website also enables parents and agencies to view the charts of the student they have placed at JRC and to keep completely current on the student’s progress.
       

   3. JRC’s Vocational Program
      As students progress, the high structure and high staffing that is employed at the start of their treatment diminishes as the students show their ability to function well under increasingly normal arrangements. Eventually students may enter a transitional program in which they learn to live with an increasing level of independence.
      
      Along with an increased level of independence, students learn independent living skills (balance checking/savings accounts, writing checks, budgeting, and paying bills).  Students learn important self care skills such as thorough showering and getting dressed on their own.  They are also taught to perform chores in their residences such as clearing their room, making their bed, washing dishes, sweeping the floor, etc.
      
      Students also learn a number of job-related skills such as:

      1. Typing. Each student studies touch typing and continues until he/she reaches a proficient level;

      2. Reading, writing, spelling and math skills. JRC’s curriculum focuses on these basics. In each of these areas we have designed our own self-teaching computer software to teach these skills effectively;

      3. Resume’ writing;

      4. Interview skills;

      5. Skills needed to obtain and keep a job. Being a student at JRC is much like working at a competitive job in the real world. Students must follow all directions of their supervisors, address their supervisors with courtesy and respect, follow a dress code, learn to work for extended periods of time at tasks that are assigned by a teacher or supervisor, etc.;

      6. Driver training;

      7. Computer applications. Students are given a chance to become proficient in all major computer applications, including Microsoft Word, PowerPoint and Excel; and

      8. Vocational training courses at Blue Hills Regional Vocational-Technical School. JRC has developed a relationship with Blue Hills Voc-Tech under which JRC sends students to take vocational courses at the school. JRC students have taken courses in auto mechanics, culinary arts, small engine repair, and graphic arts. The school helps its students obtain competitive employment in jobs that require the skills taught at the school.

      Students at this level also work at in-school compensated jobs at JRC and when successful will be given an opportunity to work at a job in the community arranged by JRC.  Please click here for a description of JRC’s vocational program.
       

   4. Integration into the Community
      JRC also teaches students to make use of the local community for recreation, shopping, laundry and other purposes.  Students who live in apartment complexes make use of the laundry and recreational facilities offered there.  As a reward, many students may choose to swim, play tennis or play basketball within the community.  Also as a reward, most of our students participate in community outings to stores, movie theatres and restaurants. Please click here for a description of JRC’s Positive Program.
       

3. JRC’s Unique and Elaborate System of Group Homes
   JRC students live in attractive, normalized homes in suburban and semi-rural areas of near-by communities that are unusually well-equipped.  All of JRC’s homes are carefully and tastefully designed with the aid of a highly skilled decorator-consultant. JRC furnishes each common area with beautiful, non-institutional furnishings and colorful prints.  A staff of special monitors visits all of JRC’s residences on a frequent basis to make sure that they remain in a clean, well-furnished condition.  Please click here for a description of JRC’s Residences.
   
   JRC provides an unusual number of amenities in each residence and the chance to enjoy these positive rewards plays an important part in motivating students to change their behavior in desired directions. The students must earn the time to enjoy these through passing their behavioral contracts and earning points or tokens. The reward systems in the residences include large screen TVs, cable or satellite TV, stereos, CD/DVD players, Netflix DVD movies by mail, TiVo digital recording systems, and Sony PlayStations.  Certain JRC residences contain indoor and outdoor recreation equipment such as a swimming pool, ping-pong table, pool table, fitness equipment, basketball backboards, barbecues, picnic tables, pinball machines and video games.  Please click here for a description of the rewards system in the residences.
   
   Most bedrooms have a TV/VCR (some with cable/satellite access), CD player, stereo, Sony PlayStation and computer and these are also used as rewards that are earned through desired behaviors.  Please click here for a description of the rewards system in the student’s bedroom.
   
   When students first arrive at JRC, they live in one of our larger and highly staffed residences that specialize in handling new admissions. Each of these "Intake Residences" serves 8-12 students.  As the students' behaviors improve, however, they advance to smaller homes and apartments that have fewer staff members and students (some have as few as four students), and more privileges. There are five categories of residences: (1) Intake Residences; (2) Intermediate Residences; (3) High Privileges Residences; (4) High Privileges Apartments; and (5) Transitional Apartments. Just as a student can advance from one residence to another by showing desired behaviors, undesired behaviors may cause the student to move back to a lower step on the residences ladder until his or her behavior improves. Please click here for a description of JRC’s residence ladder.
    

4. Supplementation of a Positive Program with GED if the Positive Program alone does not decrease the student’s problem behaviors
   In some cases, a Positive-Only Behavioral Treatment Program is not successful in treating a student with a severe behavior disorder. 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 this will inhibit or make impossible their academic/vocational and social progress. These students cannot be placed in a regular classroom, cannot take part in social activities, and cannot enjoy the rich positive behavioral program JRC offers.

   Normally, positive programming is tried for a period of several months to a year or more before the option of supplementing the treatment with restrictive procedures is considered. There are usually numerous changes made to the students’ positive programming in an effort to make behavioral progress. The chance that a newly admitted student will require supplemental aversives at JRC is only 28%. Looking at the JRC population as a whole, however, (which includes both students who have been at JRC for a longer time as well as recent admissions), at any given time approximately 50% of JRC’s population have restrictive procedures as part of their treatment programs. The other 50% are being successfully treated using positive programming alone.

   The aversives employed at JRC are safe, effective, professionally approved by a Peer Review Committee and Human Rights Committee, and are used pursuant to regulations of the Massachusetts Department of Mental Retardation and the Massachusetts Department of Early Education and Care and with prior court authorization for each student individually. Please click here for a description of the supplementary restrictive procedures employed at JRC.  The most commonly used restrictive procedure at JRC is an electrical stimulation device that JRC manufactures called the Graduated Electronic Decelerator (“GED”).  The GED unit consists of a transmitter operated by a JRC staff member and a receiver worn by the student.  The receiver delivers a low-level surface application of electrical current to the student’s skin upon command from the transmitter, as part of a designed behavioral treatment.  There are no harmful side effects.  Minor side effects may consist of reddening of the skin and, on rare occasions, a small blister may appear if the device is not making full contact with the skin.  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.  Please click here for a video on the GED.
   
   The implementation of the GED device leads to the immediate deceleration of a student’s aggressive and self-injurious behaviors, allowing that student to progress both academically as well as socially.  For the approximately 50% of the current JRC population that have the GED as part of their treatment program, the average (median) student received only one two-second application during that week. 46% received no applications at all and 78% received fewer than ten applications during the entire week. Please click here for a discussion on the GED as supplementation to a positive treatment program.
   
   The best evidence of the GED’s success is from the students who are currently or have been treated with the GED and their parents.  Please refer to the following links for testimonials from former and present students at JRC and their parents.

   Letters from parents and students
   Video testimonials from parents
   Video testimonials from students