The following frequently asked questions are intended to provide background information on the use of aversive interventions, restraint and seclusion and the stance of APRAIS. If you have additional questions or would like more information, please check out the additional resources on this website and those at the Stop Hurting Kids campaign, or contact us.
FAQ: Why does APRAIS seek to eliminate the use of aversive procedures, seclusion, and non-emergency restraint?
Aversive procedures, seclusion and non-emergency restraint are now recognized to be dangerous; leading to injury, death and trauma.
These procedures are still being used as part of treatment plans though no evidence exists for therapeutic value. It is widely accepted that restraint is not treatment; it is the failure of treatment.
The use of restraint, with the exception of brief physical intervention when someone is at imminent risk of hurting himself or others violates 8th and 14th amendment protections.
Statutes and regulations are outdated, confusing, uncoordinated, and protect some while others remain at risk.
FAQ: What are aversive procedures?
Aversive procedures have some or all of the following characteristics:
- Produce obvious signs of physical pain;
- Potential or actual physical side-effects such as tissue damage, physical illness, physical or emotional stress;
- Dehumanization of the individual;
- Significant concern on the part of family members, staff or caregivers regarding the necessity of, or their own involvement in such extreme strategies;
- Obvious repulsion, stress or concern on the part of observers who cannot reconcile such extreme procedures with acceptable standard practice;
- Rebellion or objection on the part of the individual against being subjected to such procedure;
- Permanent or temporary psychological or emotional harm.
Examples of Aversive Procedures Currently in Use:
- Contingent Electric Shock [not to be confused with electro- convulsive therapy (ECT); a procedure also subject to misuse]
- Extremely loud white noise or other auditory stimuli
- Forced exercise
- Shaving cream to the mouth
- Lemon juice, vinegar, or jalapeno pepper to the mouth
- Water spray to the face
- Placement in a tub of cold water or cold showers
- Slapping or pinching with hand or implement
- Ammonia capsule or vapor to the nose
- Blindfolding or other forms of visual blocking
- Placement in a dark isolated box or other methods of prolonged physical isolation
- Ice to the cheeks or chin
- Withholding of meals/denial of adequate nutrition
- Teeth brushed or face washed with caustic solutions
- Prolonged restraint or seclusion
FAQ: What needs to be done to prevent their use?
- Position the issue across and beyond the disability field
- Make sure families and individuals know their rights
- Seek and support the voices of people with disabilities who have been victims of these methods
- Work to make sure positive supports are available so families don’t feel that they have no other choices
- Establish a new organizational culture – make elimination of these techniques a priority, track, provide alternate tools and training, reward progress
- Make sure restraint is understood by all to be the failure of treatment and that any use signals the need to seek a better understanding of the function of the behavior and response to that function — restraint should not be part of someone’s treatment program
- Establish internal policies that don’t permit restrictive and coercive approaches — replace a culture of control with a culture of caring
- Address underlying reasons why restrictive and coercive methods continue to be used
- Select staff who value cooperation over control
- Advocate for funding that allows you to support tougher people so they are not sent out-of-state
On the federal level:
- Enact federal legislation that outlaws the use of aversives, seclusion and non-emergency restraint in all settings for all populations
- Mandate and fund venues of collaboration across disability fields – analyze models that have worked and disseminate information
- Fund research and training in positive alternatives – technology exists but hasn’t made its way into the hands of the people who need confidence and competence in alternate approaches
- Develop federal policy assuring that ALL instances of the use of aversives, restraint or seclusion are reported, independently monitored, and that an analysis of possible alternatives is conducted
- Put teeth (and funding) into monitoring, data collection, analysis, and enforcement