Positively Autism February 2012 Newsletter

Topic: Alternatives to Punishment and Restraint (Continued)

Here are this month's articles and resources on this important topic. Please feel free to pass this newsletter along to friends, teachers, and otheres. Let's get the word out about positive behavior supports and strategies! Thanks!

Keeping All Students Safe Act (S.2020): http://positively-autism.blogspot.com/2012/02/keeping-all-students-safe-act-s2020.html

Preventing and Reducing Seclusion and Restraint: http://positively-autism.blogspot.com/2012/02/preventing-and-reducing-seclusion-and.html

Overview of Positive Behavior Supports: http://positively-autism.blogspot.com/2012/02/overview-of-positive-behavior-supports.html

Positive Connections - CPI and Positive Behavior Support: http://positively-autism.blogspot.com/2012/02/positive-connections-cpi-and-positive.html

Physical Restraint and Seclusion in Schools Webinar: http://positively-autism.blogspot.com/2012/02/physical-restraint-and-seclusion-in.html

10 Restraint and Seclusion Tips for Parents: http://positively-autism.blogspot.com/2012/02/10-restraint-and-seclusion-tips-for.html

New Free Stuff! "The 3 Little Pigs" Theme Activities: http://positively-autism.blogspot.com/2012/02/new-free-stuff-3-little-pigs-theme.html

Use of Restraint - Thoughts from a Behavior Analyst: http://positively-autism.blogspot.com/2012/02/use-of-restraint-thoughts-from-behavior.html

Sample Behavior Strategy for Hallway Transitions: http://positively-autism.blogspot.com/2012/02/sample-behavior-strategy-for-hallway.html

Digital Camera Fundraiser! Please make a donation to help Positively Autism bring you new videos and teaching materials. http://positively-autism.blogspot.com/2012/02/digital-camera-fundraiser.html

February Positive Autism News: http://positively-autism.blogspot.com/2012/02/february-positive-autism-news.html

Next month's topic is Video Modeling. Let us know how you use video modeling by taking our survey here: http://www.positivelyautism.com/survey_vm2012.html

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February Positive Autism News

Community Rallies for Bullied Autistic Girl
February 25, 2012
KSLA 12
http://www.ksla.com/story/17016052/community-rallies-for-bullied-autistic-girl

Organist with autism speaks through his music
February 5, 2012
STLtoday.com
http://www.stltoday.com/lifestyles/faith-and-values/organist-with-autism-speaks-through-his-music/article_9f41edc5-5d35-504c-8798-fa03633500d9.html

Local artist's work soon to go international
February 5, 2012 
Wink News
http://www.winknews.com/Local-Florida/2012-02-05/Local-artists-work-soon-to-go-international

Beyond labels, raising autistic son yields treasure
February 1, 2012
The Jewish Journal of Greater L.A.
http://www.jewishjournal.com/los_angeles/article/beyond_labels_raising_autistic_son_yields_treasure_20120201/
I loved this quote from the article: “Instead of trying to say, ‘No, why don’t you play soccer like all the other kids?’ we’ve really encouraged him to pursue the things he’s really interested in.”

Young Man With Autism Starts Digital Scanning Business
Eastern Iowa Life
January 27, 2012
http://easterniowalife.com/2012/01/27/dubuque-man-discovers-talent-and-earns-cash/

Amazon.com recommends (the book described in, "Beyond labels, raising autistic son yields treasure")

Following Ezra: What One Father Learned About Gumby, Otters, Autism, and Love From His Extraordinary Son

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Digital Camera Fundraiser

This month, we are continuing our Digital Camera Fundraiser!

Help us purchase a new digital camera to make new teaching materials and videos.

If each reader donated just $1, we would have more than enough to purchase the new camera!

More info:

Positively Autism currently offers a variety of free teaching materials including Social Stories, flashcards, and games. I used a digital camera to create many of these materials, but our digital camera broke several months ago, and we need a new one! I would also like to expand our services to include educational videos for parents, teachers, and kids, so we need a new camera for this too. Please help us continue to offer free materials by supporing this fundraiser! Thanks for your support.

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Sample Behavior Strategy for Hallway Transitions

Here's a sample positive behavior strategy that I've used with one of my students who had difficulty transitioning through school hallways. It used a combination of video modeling and a token economy to reduce challenging hallway behavior.

http://www.positivelyautism.com/downloads/behaviorplanhallwaytransitions.pdf

More of these sample behavior plans will be added to the website soon, but you can view our current behavior resources here: http://www.positivelyautism.com/free/06reinforcement.html

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Use of Restraint: Thoughts from a Behavior Analyst

In the Arms of the Behavior Analyst:
A brief review of behavior analytic methodology and research on restraint,
and the humble opinion of one such behavior analyst
by Lorien Quirk, M.Ed., BCBA

Let me start with my opinion on the topic of restraint. Having been in an educational system for 6 years (as both a teacher and an administrator) in which I was required to complete a certification course to be employed in my position, and currently serving as one of two trainers on crisis management and assaultive behavior for a district of 35,000 children, I feel I have a good grasp on the importance of this topic. I used to think restraint was absolutely necessary. In a previous position, I assisted with restraint every day. There are places where restraint is run-of-the-mill and standard procedure for treatment. It wasn’t until I became a Board Certified Behavior Analyst at the same time as becoming a Trainer for Professional Assault Crisis Training (Pro-ACT) that some serious questioning began.

One of the main questions I am faced with is, “What is the difference between prompting and restraint?” My best answer to this (which could be argued by staunch Pro-ACT advocates) is that a prompt enables the person to achieve the desired response in order to access reinforcement. A prompt facilitates learning. Sometimes, a prompt requires physically moving the person’s body and a strict interpretation of Pro-ACT might indicate that this is violating the person’s civil rights. In my experience, it is more of a violation to deny the person access to learning and reinforcement because of a fear of “restraint.” Restraint is about inhibiting a person’s movement to decrease their ability to commit aggravated assault, not about moving his/her body in a way that is instructional.

Restraint should be applied in circumstances of aggravated assault, in which the threatened or occurring behavior would result in serious injury meriting a hospital visit. The problem we have encountered as of late, particularly with the legislative contingent, is that restraint is being used too frequently and inappropriately with students with disabilities. Given my educated description of prompting and the potential restrictions that may be imposed upon school personnel regarding physical management of students, we will continue to seriously question the alternatives. Weiner and Wettstein (1993) describe the conflict: “For those who view these [restraint] practices as worthy, the restrictions in the form of procedural requirements represent troublesome interference with treatment. In contrast, for those who view restraints and seclusion as punitive, anything short of their prohibition is inadequate.”

There is of course the issue of restraint actually being misused in a way that causes trauma, or even death, in students with disabilities. There are between 50-150 documented occurrences of death during restraint each year (“Professional Crisis Management” website). These tragedies occur for a variety of reasons, including inappropriate decisions to use restraint and inappropriate or untrained use of restraint. In becoming a Pro-ACT Trainer, I have taken on the challenge and responsibility of ensuring the people in my school system are trained and applying the principles correctly. In cases in which restraint was improperly used, it is likely that lack of training or supervision contributed to the problem, not the urgency of the need to restrain the student.

The other issue is the damage that can be caused by a student engaging in assaultive behavior. At the moment a person begins aggravated assault, they have automatically given up the privilege of unconditional access to society. Look at the laws by which all citizens are expected to abide. If someone in public begins assaulting another person, they are arrested, hand-cuffed (a form of restraint), and possibly convicted and put in jail (another form of restraint/seclusion). In my opinion, people with disabilities should not be exempt from the societal consequences of such behavior, HOWEVER, we as a society have been charged with seeking alternatives to these restrictive procedures to hold in highest regard the best interest of these individuals and their exceptional needs. As with any procedure used in schools, we must constantly question and research the effectiveness of the procedures we are using.

There are several main issues with restraint, from a behavioral perspective. There is the possibility that by using manual restraint that the restrainers are inadvertently reinforcing the problem behavior with the physical sensation of restraint, or by the close and intense attention that inevitably occurs during restraint. On the other hand, it is also possible that a restraint would punish the problem behavior, which, according to behavior analysis, can have unwanted side-effects such as increased aggression or withdrawal. In addition to this type of punishment, students who have previously experienced physical trauma would most likely find being restrained to be extremely punishing to the point of causing psychological damage. From the behavioral perspective, reinforcing problem behavior is not desired, but neither is punishment when it has the potential side-effects that can be associated with restraint.

Another fundamental behavioral issue with the use of restraint as treatment and/or crisis management is that it does not teach any new skills. As a behavior analyst, we are interested in determining the function of a behavior and teaching a new skill that may be more efficient or socially appropriate than the unwanted behavior. When a person is in restraint, they are not learning anything but how to behave to get restrained. This defeats a primary function of behavior analysis.

One research article in the Journal of Applied Behavior Analysis that touches on the subject of restraint in a classroom setting described the use of a basket-hold restraint to treat a student in a classroom who engaged in aggressive behavior. The results indicated that the use of restraint may have “either maintained or evoked” the target behavior in the student. The point of the article is that using any type of physical restraint without a full functional analysis is unwise given that it may inadvertently reinforce or punish the problem behavior (Magee & Ellis, 2001).

A similar result was found when Favell, et al. (1978) used physical restraint to treat severe self-injury (SIB) by performing a functional analysis that showed that physical restraint actually functioned as a reinforcer to the client. Though the behavior-change techniques they used in this article would most likely not be as acceptable today, they did use physical restraint as a reinforcer in a DRO (differential reinforcement of other) procedure in which the restraint was given contingent upon time without SIB. This experiment showed that physical restraint can function as a reinforcer.

Wallace, et al. (1999) explored the use of restraint with SIB and found that the flaw with their strategy of using physical restraint in their treatment was that it neglected to teach the student new adaptive skills related to the function of her problem behavior. Not only does restraint not teach a new skill, but time in restraint is time that could be spent teaching new skills instead.

Grace, et al. (1994) explored a case in which differential use of restraint was implemented contingent upon differential levels of the problem behavior in a school setting. In the study, the use of restraint was viewed as a punishment procedure to the student, and given the school’s restrictions on the use of punishment, the authors tested whether the differential use of this type of punishment would have any effect on the overall rate of problem behavior. The authors found inconsistent results which would indicate that just as with any other behavioral intervention, it must be applied consistently to have the desired effect.
As the (limited) research shows us, the use of restraint in behavior analytic practice varies greatly. There is not a reliable or predictable way to “prescribe” restraint as a treatment unless full functional analysis is conducted, which is seldom done in public school settings. According to Pro-ACT, restraint should not be used as treatment at all, but only ever in a situation of aggravated assault. The question remains, with all we know about the bad things about restraint, and all we know about the bad things that can happen if we don’t restrain, how do we proceed as a field? There is not a clear answer here, but as long as people working in the field continue to access training, supervision, and research on the topic, at least we should be able to trust our humble opinions.

References

Favell, J. E., McGimsey, J. F., & Jones, M. I. (1978). The use of physical restraint in the treatment of self-injury and as positive reinforcement. Journal of Applied Behavior Analysis, 11, 225-241.

Grace, N. C., Kahng, S., & Fisher, W. W. (1994). Balancing social acceptability with treatment effectiveness of an intrusive procedure: A case report. Journal of Applied Behavior Analysis, 27, 171-172.

Wallace, M. D., Iwata, B. A., Zhou, L., & Goff, G. A. (1999). Rapid assessment of the effects of restraint on self-injury and adaptive behavior. Journal of Applied Behavior Analysis, 32, 525-528.

Parents and legal guardians can learn more, or contact us, by going to http://www.jonathanslaw.org/.

Weiner, B. A., & Wettstein, R. M. (1993). Legal issues in mental health care. New York, NY: Plenum Press.

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New Free Stuff! "The 3 Little Pigs" Theme Activities

I've developed a page of activities and resources for a theme unit on the story, "The Three Little Pigs."

Check it out at: http://www.positivelyautism.com/free/unit_3littlepigs.html

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10 Restraint and Seclusion Tips for Parents

Check out these tips from the National Autism Association.

http://www.autismsafety.org/restraint-seclusion-tips.php

This organization also has some other great safety resources on this link: http://www.autismsafety.org/

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Physical Restraint and Seclusion in Schools Webinar

"Participate in this webinar to hear Reece Peterson, Joe Ryan, and Michael Rozalski discuss the latest information on the legislative, policy, and practice issues concerning restraint and seclusion. Federal legislation is pending that, if passed, will regulate the use of physical restraint and seclusion in school settings. The webinar will also provide an overview of the content that will be covered in more detail in the strand on restraint and seclusion at the CEC Convention & Expo in Denver in April."

Thursday, March 8, 2012, 4-5 p.m. ET
Webinar registration is only $89 for members or $114 for non-members.
http://www.cec.sped.org/scriptcontent/custom/events/webinar_detail.cfm?webinar=WEB1206

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Positive Connections: CPI and Positive Behavior Support

A free "on-demand" webinar from the Crisis Prevention Institute.

http://www.crisisprevention.com/Resources/Webinars/Positive-Connections--CPI-and-Positive-Behavior-Su

Amazon.com recommends...

Implementing Positive Behavior Support Systems in Early Childhood and Elementary Settings

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Overview of Positive Behavior Supports

The goal of Positive Behavior Supports (PBS) is to decrease and prevent the occurrence of challenging behavior by making changes in the environment to support positive and appropriate behaviors. This is often done in an “indirect” way: through teaching new skills, making environmental changes (such as using visual schedules or other visual support systems), and providing a positive and enriching environment, rather than directly intervening on the problem behaviors (ASAT).

According to the Association for Positive Behavior Support, PBS for students with autism involves various components, including:

• Functional Behavioral Assessment (FBA). See Positively Autism’s ABA Tutorial for more information on FBA procedures.
• Clearly and frequently reinforcing/rewarding appropriate behaviors.
• Changing the environment to minimize “triggering events” the precede problem behaviors.
• Making efforts to enhance the individual’s quality of life through increasing community involvement, providing opportunities to make choices, increasing positive relationships with others, etc.

The Association for Positive Behavior Supports offers a variety of PBS fact sheets here: http://www.apbs.org/PBS_Practices.htm

The Texas Autism Resource Guide for Effective Teaching lists Social StoriesTM and teaching communication skills as examples of positive behavior support strategies.

References and Resources

Association for Positive Behavior Support: http://www.apbs.org/new_apbs/autismDesc.aspx

Association for Science in Autism Treatment (ASAT): http://www.asatonline.org/intervention/procedures/positive.htm

Center on Positive Behavioral Interventions and Supports: http://www.pbis.org/

Texas Autism Resource Guide for Effective Teaching: http://www.txautism.net/docs/Guide/Interventions/PBS.pdf

Positively Autism's Collection of Social Stories: http://www.positivelyautism.com/free/09social.html

Positively Autism's ABA Tutorial: http://www.positivelyautism.com/aba/

Positively Autism's "Intro to Autism" Tutorial: http://www.positivelyautism.com/autism/

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Preventing and Reducing Seclusion and Restraint

by Kym Grosso of Autism in Real Life , from a blog post entitled, "Students Traumatized in Special Education Across America, Seclusion, Restraint, and Aversives."

At the heart of this issue, many schools lack understanding about autism, why behaviors happen, how behaviors can be communication or sensory related, how calming and verbal deescalation techniques work and how to modify behavior using positive behavior support. Often, our children cannot speak or communicate well, so they use behaviors as a form of communication to get their needs and wants known. Because school staff do not understand these behaviors as a way for the child to try to communicate, the child is punished and the need goes unmet.

In addition to looking at behavior as communication, schools should consider creating comfort rooms or quiet tents available so children with autism can seek relief from noise and other stimuli. Sensory rooms should also be available for our children so they have access to the tools in their individual sensory diets in a quiet environment. Sensory can be an effective way of helping students regain control of their emotions. Instead of letting (or pushing) a child into crisis, a sensory area/room can be a helpful deescalation resource.  Over time, many kids can learn what sensory techniques help them most so they can self-regulate independently. Schools can even make sensory available in the regular classrooms via portable sensory kits as a way of having sensory objects available without having to leave the room. I can tell you from personal experience that schools, even within the same district, often vary in their knowledge regarding sensory and the resources they have available as far as creating sensory rooms. There are many online resources available that list research and information about how to reduce seclusion and restraint via comfort and sensory rooms ^{(8)(9)(10)(11)}.

In the end, if schools really want to eliminate seclusion and reduce restraint, the message needs to be advocated from the top down. Administration needs to take a stand and create a culture which is focused on learning how to prevent crisis situations so the need for restraint is reduced. A good place to start is by reading the Six Core Strategies to Reduce The Use of Seclusion and Restraint Planning Tool, created by the National Association of State Mental Health Program Directors. This tool, Six Core Strategies, has been shown to successfully reduce seclusion and restraint in mental health facilities as well as schools (Azeem MW, Aujla A, Rammerth M, Binsfeld G, Jones RB, 2011)^(12)(13)(14). In addition, there is a free DVD, Leaving The Door Open: Alternatives to Seclusion and Restraint, created by SAMSHA which can assist schools in training staff on alternatives to seclusion and restraint. SAMHSA's website has information about alternatives to seclusion and restraint. The TASH website has information as well.

In order to prevent and reduce seclusion and restraint, schools need to have the desire to learn and the ethics and compassion to seek alternatives. Over a decade ago, our nation's mental health industry recognized the trauma and potential risks of seclusion and restraint. Schools can change too, but they have to acknowledge the problem before they can reach a solution⁽¹⁷⁾. And if administrators lack the compassion to recognize the trauma this practice causes, they should at least be looking at the potential cost savings to taxpayers. The business case for reducing seclusion and restraint has been well documented ⁽¹⁸⁾.

Read the entire article here.

Excerpt reprinted with permission of the author.

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Keeping All Students Safe Act (S.2020)

I received an e-mail update from the Autism Society of America about this legislation that would ban certain types of restraint and seclusion. You can learn more about the bill and e-mail your Senators about the bill here:

http://www.autism-society.org/news/please-email-your-senators.html

Many Applied Behavior Analysis procedures can be used as alternatives to restraint, seclusion, and punishment. Positively Autism offers free ABA and Autism training and resources here: http://www.positivelyautism.com/tutorials.html

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