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Judge Rotenberg
Center recertified for one year
(February
2008 Issue)
By Nan Shnitzler
The Massachusetts Department of Mental Retardation (DMR) has reauthorized
the Judge Rotenberg Center to use controversial aversive behavior
modification therapies, including skin shocks, provided the center
adheres to certain conditions, some of which were made during the
previous evaluation in 2003. The center in December got a one-year
extension rather than a two-year certification, as it has received
over the past 10 years.
The 2007 evaluation team, which began its review in March, was
not satisfied that the Canton-based school had demonstrated that
Level III interventions addressed only the most difficult, dangerous
or harmful (to self and others) behaviors; that the risks of adversives
had been considered; and that benchmarks were in place for gauging
their effectiveness.
"In the case of proposed Level III interventions, there must be
sufficient data to support their use," says the certification report.
The center was also faulted for individualized behavior plans that
failed to specify a rationale for each intervention, analyze behavioral
contexts and triggers or evaluate treatment alternatives. Team members
found "a disturbing sameness" to the plans including identical lists
of interventions.
"The use of generic "templates" in functional assessments should
be discouraged," says the report.
The team lauded the center's software for charting educational
and behavioral goals and suggested its expertise in computerization
could be devoted to compiling a single, integrated, accessible case
file containing medical records, court reports and behavior plans,
as specified in the previous certification report.
The previous evaluation team was concerned about the delay between
objectionable behavior and the aversive consequence when students
were awakened to receive skin shocks. The 2007 team wrote that
JRC had discontinued the practice of awakening students, yet that
is what happened during an incident in August when someone telephoned
posing as a supervisor and ordered shocks, which were administered.
JRC fired the staff on duty that night and must come up with a corrective
plan for DMR review.
DMR monitors compliance in large part with quarterly reports and
reviews, but says it will move to a more aggressive schedule which
was to begin in January.
"The state is putting in place a Continuous Quality Improvement
effort through joint monitoring by the Department of Mental Retardation
and the Department of Early Education and Care and in partnership
with the agencies involved in placing individuals at JRC. We are
also pursuing avenues for improving collaboration in our licensing,
certification and incident reporting processes," emailed Jennifer
Kritz, deputy communications director for the Executive Office of
Health and Human Services.
The Canton-based Judge Rotenberg Center serves about 250 students,
mostly minors, who have severe mental illness, retardation and autism.
About 60 percent of the students, per the report, have been court-authorized
to receive Level III interventions. It is the only school in New
England and possibly the country that regularly uses skin shocks
as treatment.
"To think that aversives are necessary given that many institutions
don't use them just seems illogical," says Leo Sarkissian, executive
director of the Arc of Massachusetts. Like other critics, he wants
a legislative ban on skin shock therapy because he says regulators
can't properly oversee it and because mistakes have more drastic
consequences than other forms of therapy.
Rep. John W. Scibak (D-South Hadley), who has a doctorate in developmental
disabilities and has used shock therapy in extreme cases, does think
oversight can be improved and has filed a bill elevating aversives
to a Level IV intervention with stricter controls for their use
and evaluation.
"It's not the procedure of choice," he says. "But in my career,
sometimes aversives were the only things that worked."
The Judge Rotenberg Center considers the certification process
a normal part of doing business.
"We are working very closely with the state Department of Mental
Retardation on its conditions for recertification and expect we
will be able to satisfy all of their concerns," emailed Ernie Corrigan
JRC spokesman on behalf of center founder and executive director
Matthew L. Israel, Ph.D. "DMR understands that JRC's reward/skin
shock therapy is used as an alternative to psychotropic medication
and is required for only approximately half of our student population
for whom our positive reward and educational procedures prove to
be insufficiently effective to treat seriously harmful behaviors."
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