Cherry Hill's Chokey!

We have an area in our home that my son calls his "safe zone." If he feels overwhelmed or stressed he goes there and sits to regain his composure. He initiates it and it is just a quiet area in our living room at the far end where the lighting is dimmer and the distractions are fewer. I call it a "reverse time out" because it eliminates the problem behaviors that would result in a time out for a typical child. It is a means of proactively addressing the triggers that would have resulted in rage type behavior.

I am highly sensitive to the subject of physical restraint and or physical seclusion. When my son was in Kindergarten he had been physically restrained quite often because of explosive behaviors. The end result was that his self confidence was reduced, he was embarrassed and humiliated in front of his classmates and began to have a negative attitude towards woman -- since it was always a female that restrained him. He became so frustrated by this that he often said that he wanted to die. He eventually began making suicidal threats. The physical restraint did nothing to prevent the explosive behaviors or teach him the skills necessary to regulate his behavior. After witnessing these behaviors first hand, our then Director of Special Education, Charlie Lang, ordered a new FBA and the Behavior Analyst carefully constructed a "positive" Behavioral Intervention Plan. The new plan is focused on teaching the skills for which he is deficient, rather than punishing the resulting behaviors.

My son's behavior plan is very consistent with the procedures outlined in the book "The Explosive Child" by Ross Green, PhD. Dr. Green, along with some other psychologists from Boston General and Harvard University put together a behavioral program called the Collaborative Problem Solving (CPS) approach. The CPS model is based on the belief that challenging behavior should be understood and handled in the same manner as other recognized learning disabilities. In other words, difficult children and adolescents lack important cognitive skills essential to handling frustration and mastering situations requiring flexibility and adaptability. The CPS model helps teachers (and parents) to teach these skills and it also helps children to realize the importance of problem solving and conflict resolution. We have seen tremendous results using this plan for my son.

There is information available online regarding the CPS approach. Here are a few links:
Center for Collaborative Problem Solving
The Explosive Child
Foundation for Children with Behavioral Challenges

Late last year, after a terrible experience in the mainstream setting, my son was placed back into a self-contained special needs classroom. They had an area in the classroom used for sensory breaks. The area is about the size of a double bed. The wall is recessed and makes up an area of about 6' wide by 4' deep. There was a duvet cover on the floor filled with chunky foam blocks. It provided cover for the floor and I guess some padding. I believe there was something over the concrete walls, too. It was a very dimly lit area that was obstructed by large storage cabinets. They were strategically placed to provide an opening to the area of about 2 to 3 feet wide. It was used when children needed a sensory break and was similar to our "safe zone" at home. I was aware that my son had been in this area several times. But again, this was used for children that requested a sensory break.

Last night I attended the Parents Forum held by the Cherry Hill Special Education PTA. At one point during the "parents only" portion of the meeting, someone mentioned a similar technique that was being used at Russell Knight School. Apparently they have a "closet" that has been padded with gym mats that they are calling a "Quiet Room." It turns out there is also one at Kilmer School. When the parents began talking about this I quickly realized that it was not being used as a "Safe Zone." It is being used to place children in when they have meltdowns or become non-compliant.

I asked the parent that mentioned this to clarify how this was used. I thought, I must be hearing this wrong! She said that it was a closet, with a door, no windows and padding on the walls! When a child became non-compliant one day, the child was placed in this closet. To make matters worse, the woman that spoke about this has a non-verbal child. Her child would have no way of telling her if placed in a closet.

I cannot even begin to describe the emotions in the room as parents listened to this Mom speak. Some looked horrified, others were holding back tears and there was anger and pain on the face of every parent in the room. My heart broke for this parent that became aware of this by accident. She had no way of knowing if it had been used on her child; and if so, had no opportunity to dispute the use of such aversives because no one had ever mentioned this type of procedure being used in Cherry Hill. I began to think about the tremendous psychological impact this must have had not only the child placed in the closet, but on the others that may have witnessed this.

During the question and answer session with Israela Franklin and Jim Gallagher they addressed this concern. They admitted that they had knowledge of a "Quiet Room" being used in at least two schools in our district -- Kilmer and Russell Knight. Jim Gallagher did his best to cast this in a positive light. He said that sometimes it is necessary to escort a child having a meltdown to the "quiet room." He did not mention the other uses, such as non-compliance, task avoidance, etc.

While all of this may sound perfectly acceptable to administration with their well chosen words of explanation -- the only words that ran through my mind were "why and how."

First, the "why" questions:
Why were these closets turned into "quiet rooms" without telling parents in advance?
Why was this procedure not explained to parents in an IEP meeting if there was even the slightest chance that it may be utilized?
Why would a child be allowed to reach such a high level of distress?
Why would a child prone to meltdowns not have a positive behavior plan in place?
Why would we not have trained staff to spot the child whose frustration is escalating and intervene before a crisis?

Perhaps it did not occur to anyone that the best way to handle a crisis is to prevent it from happening in the first place!

Now on to the "how" questions:
How do you justify the use of aversives when you did not make a plan to avoid this?
How is it that you go about "escorting" a child in a full blown rage out of a classroom? When they reach that level they are extremely combative. The mere act of trying to relocate them could bring injury to the child or even the staff attempting to physically move the child.
How is it that parents were not made aware of these questionable techniques prior to their use? How are these "quiet rooms" actually used? Are non-compliant children placed in these padded cells (for lack of a better phrase!) or is it just for full blown rages? There seems to be some indication that they are used for more than "meltdowns."
How is this explained to the other children in the room. Surely they are fearful and perseverating on the fact that it "could" be them next!

I am urging every parent that reads this blog to pass it along to other families. Mr. Gallagher indicated last night that some school principals are setting up these secluded areas in their schools. Please ask at your child's school if there is a "Quiet Room" or "Quiet Area" or any type of secluded setting, even if it is only used for a "sensory break." If there is, request to see that area so you know in advance what could happen. And please alert other parents to the existence of such an area.

I would also encourage parents to send a written letter indicating that you are against the use of physical restraint and the use of aversives such as these "quiet rooms" if you do not want this used for your child. Obviously, there may still be occasions when a child would react in such a manner that it would become necessary for their own safety for some type of preventative action by a staff member. But this needs to be clearly defined in a Crisis Intervention Plan and limited to true emergencies.

I think it is also important to recognize that in certain situations there may be children who have such severe sensory integrative dysfunction, that they may need an area for which to escape. In that situation however, it should NEVER be used as a punishment area. The child needs to be taught to go to that area independently and be permitted to leave that area willingly.

Any parent that is concerned with the possibility of disruptive behavior by their child, should have this addressed in a formal Behavioral Intervention Plan (BIP). I cannot stress enough the importance of the BIP! It tells the staff working with your child what is and isn't appropriate for your individual child. You most certainly do have a say in this! The behavior plan should be consistent with interventions used at home. Consistency is the key to effective behavior plans.

The Autism National Committee has had this to say on the use of such aversives as physical restraint and quiet rooms:
"[Physical restraint] should only occur when there is substantial threat of injury to self and others. Behavioral restraints are neither treatment nor education."

"The use of restraints should be considered a failure in treatment. We totally condemn the use of behavioral restraints. "

"The use of aversives is a human rights issue and a civil rights issue. When we allow punishments to be used on persons with disabilities which would be illegal if used on persons without disabilities, we are denying them equal protection under the law. Even our other devalued populations - people who are elderly, homeless, or in prison - cannot legally be "treated" with aversives, nor do we permit animals to be trained or treated by these means."

Additional Info is available on this subject at:
Autism National Committee
Asperger's Express
Kids in Confinement
Autismvox

A parent sent me this this morning: Remember the novel Matilda? The evil headmistress Agatha Trunchbull puts children in a horrific torture closet called The Chokey! Chokey is British slang for a prison. Trunchbull's treatment of her students is nothing short of child abuse and she seems to believe intimidation is the best method of teaching.

Is this really how we want to teach our children appropriate behaviors, social and communication skills?

This is an important issue that parents of both special needs children and typical children need to consider. If our school district is going to implement such aversives than every parent in the school district needs to know about this!

*Originally published in the Courier Post, Autism Blog, Kathi Magee: On Autism, 10/18/07.