Category Archives: Behavior Analysis

Amazing Success Story

April 25, 2014Behavior Analysis, Charting Progress, JRC Experience, JRC Programmedication, skin shock, successrvh

I have been a clinician at JRC for over 20 years. People often ask me how I lasted for so long in such a controversial program. The answer is very simple. I have been a part of a team that has improved the quality of life of so many people. None of the negative comments or ridiculous misrepresentations of JRC has ever outweighed seeing a smile on a face that never smiled, or a “thanks for the help” from someone who entered the program full of anger. I’m in touch with many people who spent time here who we were able to help move on to other settings.

I remember one client, AS, who came to us years ago after 12 years of failed treatment. She spent nine years in 11 different residential or hospital settings in Massachusetts, but was expelled or transferred due to her serious aggressive and self-injurious behaviors. During this period she was treated with 14 medications, Paxil, Benadryl, Ritalin, Desipramine, Dexedrine, Trofranil, Trilafon, Lithium, Clonidine, Depakote, Klonopin, Haldol, Seroquel and Zyprexa in various combinations, without any significant improvement in her behaviors.

In AS’s last Massachusetts placement, she experienced 120 physical and 40 chemical restraints in a 28 week period. When all in-state placements were exhausted (I guess it was felt that JRC was too controversial) she was sent out-of-state where, again, medications and other treatments failed and, after 8 months, she was hospitalized in Boston. She was then finally referred to and accepted to JRC. (I like the fact that we don’t reject anyone because their behaviors are too intense.)

When AS entered JRC she was taking Klonopin, Prozac, Ritalin, Tegretol, Seroquel, Wellbutrin, Naltrexone and Lithium. No wonder she couldn’t control her behaviors! When she arrived at JRC she was in an ambulance and strapped to a gurney – they felt it was the only safe way to transfer her. I found her quite charming with a good sense of humor.

We immediately set up a behavioral program to help her reduce her dangerous behaviors. She did okay for a few days but then became highly assaultive and attempted to injure herself. The honeymoon was over.

custom composite chart — Our student’s chart shows her significant behavioral improvement.

Over the next month she had over 1,000 dangerous behaviors and required staff intervention to keep her and others safe. Staff injuries included broken ribs.

Given her extensive history of failed treatment and the fact that her dangerous behaviors were increasing steadily we discussed seeking court authorization for the use of contingent skin shock. She agreed that it was worth a try since nothing else had worked and she yearned for a more normal life. She wanted to live independently in the community someday.

She was appointed an attorney by the Court to represent her and she told her attorney that she wanted to give contingent shock a try. A hearing was held before a Judge in Probate Court who later authorized the use of contingent skin shock.

Success!

The first week AS received 8 contingent skin shocks for aggression and self-injury with 7 on one day. Over the next 52 weeks she received only 3 more. She was completely weaned off of all psychotropic medications and she was thrilled about that.

One of the biggest but immeasurable changes was her attitude. She went from rude and belittling to happy and social. Her self-esteem skyrocketed. The medications over the years had led to a large weight gain and she began to lose weight. She was clearly proud of her progress and actively participated in her educational program.

Due to her success we began to fade out the use of contingent skin shock after six months of treatment without any negative impact. She testified at the Boston State House against a bill to ban this form of treatment, telling the legislators how this treatment gave her back a life. She went out into the community weekly, which was not possible at all for the 12 years before coming to JRC.

AS was completely weaned off the contingent skin shock treatment within the first year and she was working toward her high school diploma. She did have one small set-back and the skin shock was reinstated for a short period, but in general she just continued to improve in all aspects of her life.

Over the course of her stay with us, about 27 months, AS was able to complete her education and receive her high school diploma. She took courses in a local vocational school. She started a paid in-house job in JRC’s Human Resource Department, and later a job at Friendly’s. (When she came to JRC the last place I could see her working was a restaurant where she would have to deal with many different people each day.)

She went out and got her learner’s permit as she prepared to live on her own. When she was ready to leave JRC, she moved to a group home and then later to independent living. She got married, divorced, remarried and had a baby. She trained to become a home health care aide.

I have kept in touch with AS over the many years since she graduated from JRC. Years after she left we asked if she’d like to speak at the State House again about her years of mental health treatment and how she’s done since she left JRC. She agreed to meet me in Boston, and I waited for her at the entrance to a nearby parking garage. I was brought to tears seeing her drive up in her large SUV. She looked like a confident businesswoman going to the office.

AS told the senators and representatives that day, that without JRC she would have died from her self-injury or been jailed due to her assaultive behaviors. To this day I get goose bumps every time I recount the story of first meeting her strapped to a gurney, and her subsequent progression up to seeing her driving into Boston in that large SUV. I still see her smiling face every day, as we have a picture on the wall of her working at Friendly’s.

And this is only one of the dozens and dozens of reasons that I continue to work at JRC.

Yes, we can help your difficult child

April 6, 2014Behavior Analysis, JRC Experience, JRC ProgramRA

As the Referrals Director at JRC, I have the opportunity to encounter a number of agencies that deal with a very difficult population of developmentally and emotionally disabled individuals.

These agencies include school districts, psychiatric hospitals, public and private mental health agencies, and criminal courts and affiliated agencies, as well as other service providers. Most often I am visiting these agencies because they have come in contact with a student who has defied other means of treatment or has such difficulties in his or her current setting, that no other program is able to offer educational services.

As all of my colleagues here at JRC do, I stress our ability to effectively educate students without the use of medication, and our willingness to accept even the most difficult students without the threat of expulsion. Often parents and agencies have received assurances from programs that they are able to manage students with severe maladaptive behaviors, only to have the child referred back to the school district or mental health agency that is responsible for ensuring educational and treatment services.

When my colleagues and I meet with agencies and assure them that we are committed to working with the most difficult to treat individuals, we are often met with a fair amount of skepticism. It is gratifying to have the opportunity to work with students who have been expelled or rejected from other programs and see them realize significant progress and achieve goals that they did not think were possible.

student at computer — JRC student concentrates on her academic work at her classroom computer.

I recall one young lady who was brought before a Family Court Judge in New York City after having been charged with criminal offenses. The Judge felt that due to the adolescent’s criminal behavior and gang activity, she was not worthy of placement in a private school, which was evidenced by her behavior in court. At the time, the young lady refused to properly address the Judge; she refused to remove her feet from the table and would not take her hat off. The Judge was also concerned that the young lady would elope (run away) once admitted to our school, and offend once again in the community. In spite of her reservations, the Judge was convinced to allow the girl to be admitted to our school. However, the Judge did offer a stern warning that the girl was due back in court in several weeks and the court would not be pleased if the girl failed to attend the hearing or committed another criminal offense.

When we returned to court several weeks later for a subsequent appearance, our student was in a much better frame of mind than at her previous appearance. She was genuinely happy and sociable. Her attire and manners were appropriate and she was very cordial. When the Judge met with her, she was astounded at the transformation in this young lady. Our student stood up when the Judge entered the courtroom, addressed the court in a pleasant manner and thanked the Judge for the opportunity to attend school. The Judge was speechless and could only shake her head.

After a minute or so, the Judge asked our student if she was taking medication and our student exclaimed, “No, they don’t make me take medication.” The Judge then asked our student to what she attributed such a drastic change in her behavior and demeanor. Our student explained that she had never been treated with such respect, in spite of some difficult behavior that she was displaying in the first several weeks of her admission to JRC. She told the Judge, “No matter how bad I am, they still treat me well and take good care of me. I really want to get my education.” The Judge looked at me and said, “I don’t know how you people did it, but I can’t argue with the results. I am quite pleased with the progress of this young lady”.

I have been before this Judge since then and her skepticism has disappeared.

Functional Behavioral Assessment at JRC

April 3, 2014Behavior Analysis, Charting Progress, JRC Experience, JRC Program, Special Needs SoftwareNL

The Applied Behavior Analysis (ABA) literature is consistent with regard to the value of thorough and precise assessment of the functions of dangerous/disruptive behaviors. Such assessment (whether experimental functional analysis or descriptive functional behavioral assessment) can help to form the development of a behavior intervention plan that is better tailored to the individual’s clinical needs.

At JRC, assessment of the functions of student problem behaviors is ongoing throughout the student’s JRC enrollment. When the student is first admitted to JRC, a reinforcer preference assessment occurs over the course of the student’s first week. Data are taken regarding which stimuli/events may serve as motivating rewards in the student’s BIP.

Simultaneously, the student’s JRC Clinician begins to collect data, across all environments, on the student’s positive and negative behaviors, as well as related triggers and consequences. Assessment methods include interviews and questionnaires administered to the student, family, and staff; collection and graphing of a broad range of behavioral frequency data 24 hours per day; and direct observation of the student across all natural environments.

JRC’s main video monitoring suite enables views of all JRC spaces.

Direct observation, a cornerstone of good ABA, is particularly easy to do at JRC because of JRC’s Digital Video Recording (DVR) system. Most environments (e.g., classrooms, group homes) are equipped with DVR cameras so that JRC Clinicians are able to observe their students’ behavior and related environmental antecedent and consequent events.

JRC’s specialized standard celeration behavior charting system, when combined with the direct observation capability provided by JRC’s DVR system, means that JRC’s Clinical staff are able to conduct ongoing and comprehensive functional assessment throughout the student’s enrollment at JRC. Such ongoing and comprehensive functional assessment is an improvement upon the once-per-year static and narrowly focused functional assessment that sometimes occurs at other settings. For more information regarding JRC’s functional assessment methods, please feel free to reply to this post.