This is part of a series of diaries on proposed regulations to allow public schools, preschools, and state-approved private schools in New York to use aversives and noxious stimuli on disabled children. The Board of Regents will be considering the proposal at their meeting on June 19, and I have urged concerned parents and educators to contact the Board of Regents to express their concerns about this proposal.
In response to one of the earlier diaries,
vox humana wrote:
I know you said your next diary would deal with the economics of this issue, but I hope you might also have one that would explain this proposal and its alternative(s) from the point of view of an actual educator needing to employ these interventions in, say, a mainstreamed middle school classroom.
This comes from the husband of a teacher who has been mortally threatened by both one student and one teacher, and who once had to break up a knife fight in a class. Given such a background, could such a teacher conceivably have different standards for application of restraint than someone coming at the issue from your viewpoint?
It's a great question, and I hope I can do it justice. To answer it, I'm going to try to stay in just one of the many hats I actually wear: as a paid consultant to school districts who need help developing appropriate plans for students with disabilities. As background: most of the cases I am asked to consult on involve children with what are generally considered 'neurological,' 'emotional,' or 'neuropsychiatric' disorders, including Tourette's Syndrome (TS), Obsessive-Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder, Depression/Dysthymia, Asperger's/HFA, PDD-NOS, etc. I have also worked in urban schools, so I'm sensitive to vox humana's concerns about violence in school settings and the risk of physical harm to teachers.
In all of the years I've been consulting, I've never recommended aversive controls or noxious stimuli as they are defined in the new proposed regulations. I've never recommended them because frankly, they've never really been needed -- even though school or district personnel thought they were needed when they first contacted me.
There are several things I've consistently noted in my consulting work, and I say this with all due respect to teachers:
Most teachers were not adequately trained at the pre-service level of training to recognize signs and symptoms of the disorders I mentioned above.
Most teachers do not receive continuing education or in-service programs that are on the kind of sophisticated level they need to understand these disorders and the research-validated methods for addressing symptoms of those disorders so that they can be proactive in behavior management instead of reactive.
Most teachers do not get an adequate grounding in behavioral technology or classroom management. They tend to get one course in behavior at the undergraduate level, and that's not near enough. As a result, the behavior interventions they design are generally inadequate and ineffective.
Most teachers do not get adequate ongoing support in the sense of the state education department or their district providing them with training and information on research-validated methods for classroom management and behavior management. Many districts do not have full-time building psychologists who can assist the teacher, either.
Most teachers do not get adequate support from their building administrator (principal) or the district in terms of getting a teaching assistant or trained aide or paraprofessional in the classroom when up to 33% of the students have special needs and one teacher is unlikely to be able to address all of those special needs.
OK, I realize some teachers may feel insulted by those comments, and I don't mean them as criticism of the teachers but as criticism of those who should be supporting teachers.
Now let me give you some examples of how it plays out, drawn from my experiences. All names and some details are altered to protect confidentiality:
Example 1. "Johnny" was a sweet 11 year-old with TS, OCD, PDD-NOS, ADHD, and Learning Disabilities (LD) pleaced in a self-contained class in a mainstream building. His district asked me to help them with a Behavior Intervention Plan (BIP) for him. I met with the staff before I ever saw the kid or met him, but one look at their proposed plan was enough for me to say, "You can't do this. First, you're targeting tics that he can't control and you're targeting them by applying negative consequences that are probably going to backfire and make his tics worse. Second, you've listed 6 goals in this BIP, which is about 4 or 5 too many, and for each one, your goal is just to decrease the "behavior." And in all cases, these "behaviors" are neurological symptoms."
Now I understand why the school personnel had come up with that plan. Some of his tics and compulsions were self-injurious, and they really wanted to help him reduce self-injurious behaviors. But a consequence-based approach is unlikely to work, might make him much worse, and they hadn't conducted a refined enough Functional Behavioral Assessment to really understand why his symptoms were increasing when they were. To make a long story a bit shorter, I took them back to Square 1, and we developed a different plan based on different goals and using positive-based supports at the right frequensity and intensity. The revised plan also included teaching the teachers what to ignore and not respond to at all. Within a short period of time, we had him starting to mainstream. Mainstream posed its own challenges and I was called in again to help, as described next.
Example 2. "Johnny's" problems in his mainstream class was mostly due to his perseverative questioning of the teacher which interfered with the other student's ability to learn and the teacher's ability to teach. Trying to handle this on their own, the school responded by removing "Johnny" from the classroom each time he got "stuck" and interfered with the class. Not surprisingly, that didn't work well, and then they called me in. I met with "Johnny," and he and I developed a plan that he thought would work for him (after acknowledging that his behavior was causing a problem for his peers and his teacher and that he wanted to be a good classroom citizen). "Johnny's" plan involved a few elements, and we asked the teacher and aide to provide him with the support he felt he needed. His plan also included, at his own suggestion, removal from class if all of the previous supports failed and he was still perseverating. The plan worked, and he never needed to be removed from the room.
Example 3. Parents of a student in a very very large urban school district (can you guess?) went to due process over the inappropriate handling of their child, who had TS, OCD, and ADHD. The child was so mishandled in his previous placement (the principal had literally refused to allow the teacher and staff to get training) that he had gotten physical and was at risk of totally 'losing it' in the building. As part of the hearing officer's decision, the district placed "Joey" in a different school to give him a clean start and hired me to come in to train the staff and to work with them on how to handle him. The teaching staff were clearly worried about the potential for outbursts and throwing desks, etc.
Through the staff development and ongoing consultation with the teacher, and by really training the paraprofessional as to how to approach -- and when not to approach -- "Joey," Joey made fantastic progress in his first year in the new school. Our first goals were not oriented to decreasing aggressive or unwanted behaviors, but rather, to get him to feel safe (because he had been so abused in his previous placement), to work well with his aide, and to seek adult support when he needed it. During the second year, our goals related to improving independent academic functioning and helping him make and keep more friends. During that second year, we faded out the aide's presence from 1:1 full-time to select settings and situations. By the third year, the aide worked with Joey just at the beginning and the end of the day to insure adequate organization, and we tackled homework issues. By the end of the year, not only was he an A student and doing all his homework, but he had lots of friends, was more responsible at home, and really could have been declassified from SpEd and just given a good 504 Plan.
On only one occasion in the first year did "Joey" ever get into a physical altercation, and that was when his aide was out, and they assigned a non-English-speaking aide to him for the day. The aide had never been trained, the teacher was out of the room at a CSE meeting, "Joey" couldn't communicate with him due to the language issue, and he got frustrated with another kid and started shoving. After that incident, the school made sure to have a trained backup aide and there were no further problems.
Example 4. "Patti" was a middle-school female with pretty severe TS. As part of her tics, she'd actually fall to the floor and bang her head against the floor. It was scary for her peers, her teacher didn't know what to do, and the building principal wanted "Patti" out of the building, period. When the district wouldn't move "Patti" out of the building, the principal decided that aversives and punishment were necessary. Not surprisingly, that only made "Patti's" tics and symptoms worse. I came up with an alternative plan that was acceptable to the teacher and to Patti's parents -- and to Patti. The plan worked really well, actually, but the damned principal wouldn't support the teacher, and we finally decided to remove "Patti" from the building to protect her from the principal.
Example 5. A middle-school boy with severe OCD had a compulsion that if he started reading something, he had to finish it. His teacher asked him to put the book away because it was time to start the next activity. He kept reading. The teacher tried to gently take the book away. He jumped up and tried to run out of the room with the book so that he could go finish reading it. The teacher blocked the door to keep him in the room. Extremely anxious and totally dysregulated by now, the boy punched/shoved the teacher out of the way and fled. The boy was later suspended out-of-school for assaulting the teacher. Now who's fault was that one?
One of the key elements unifying all of the above examples is that at the outset, the staff didn't really understand the kid's disorders or how to approach things proactively. Once they were given adequate training and support, they were able to manage the kids without aversives and in less restrictive programs.
There is, for example, a tremendous literature on ADHD in school settings and classroom environment factors and individual strategies that make a difference. Yet when I go into the schools, most teachers have never been given the information about simple things like what kind of seating arrangement works best for kids with ADHD if you're teaching new material. Or they've never been told or shown how to effectively use color to organize and enhance attention.
One of the key reasons kids with disabilities "crash and burn" in middle school is due to executive dysfunction (what some of us call "terminal disorganization"). There are techniques that mainstream teachers can use on a building-wide, classroom-wide, and individual level to promote organization without the use of aversives or time-out, etc. And the more you address the academic issues correctly and with positive supports, the less behavior issues you'll have. Why the state education dept. hasn't disseminated this information to the teachers is beyond me, but I've yet to teach a conference for educators where more than a handful knew about these techniques.
So... when vox humana or anyone talks about "needing" to use aversives, I tend to beg the question, because until you've really used classroom environment, classroom management, and individual supports correctly, you haven't really demonstrated that you really "need" to use aversives on a planned and non-emergency basis.
Yes, sometimes physical interventions -- including restraint -- may be necessary for emergency reasons, and staff should be trained in appropriate methods so that neither they nor the child get hurt. But there's a difference between allowing restraint for emergencies and allowing it as part of a behavior program. Similarly, there's some literature that shows that the proper and selective use of time-out may be beneficial, but it's so haphazardly applied in most cases that it's often ineffective, or worse, harmful to the child. Note that time-out rooms and emergency restraints are handled in separate provisions of the proposed regulations and are not included in the definition of "aversives."
And thus endeth this long rant.... now you can all throw rocks at my head. :)