Judge Rotenberg Educational Center
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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.
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.
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.
The most commonly used “aversive” procedure at JRC is an electrical stimulation device[1] 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.
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 psychologists or clinicians who supervise the student’s treatment team and are responsible for overseeing all aspects of the student’s treatment program.
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%.
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.
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.
[1] 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.
