Part 2

The Contingent Food Program is also widely applied and designed to use hunger to motivate students to be compliant. This intervention requires that a student “earn” a portion of his or her daily prescribed calories by not engaging in identified target behaviors (as per his/her behavior contract). If the student passes each of the behavioral contracts that are set for him/her, he/she will earn 100 percent of the planned calories for each meal served. If the student fails to pass one or more of his/her contracts, the student is not given the food portion(s) that is (are) the potential reward(s) for that contract. Food portions not earned are discarded by the staff and/or student. If the student does not earn the minimum daily total of calories by 7:00 PM, then the balance necessary to bring the total calories eaten to the student’s targeted calories is dispensed to him in the form of nonpreferred staple food (e.g., consisting of mashed food sprinkled with liver powder). The Court Monitor must be informed when a student has been required to consume the full calories in the form of nonpreferred food for a period of two weeks.
The Specialized Food Program is more restrictive. For students on the Specialized Food Program, JRC does not offer make-up food to compensate for food that the student missed by failing to pass his or her contracts unless the student has eaten 20 - 25 percent or less of his normal daily caloric target. If the student has eaten 20 - 25 percent or less, he/she is offered make-up food to bring him up to the 20 - 25 percent level. The Court Monitor is informed whenever the student receives no more that 20 – 25 percent of the daily caloric goal for two consecutive weeks. Daily weights are maintained and ketone levels are measured when the prior day’s intake is less than 80 percent of the recommended daily caloric intake.
• Currently there are ten NYS students on the Contingent Food Program and one NYS student on the Specialized Food Program.

The GED device may also be sent home with NYS parents after they receive training from JRC regarding the use and application of the GED. One record reviewed indicated that the student went home for a vacation break and a family member, to administer punishment, used the GED device. However, the report did not identify which family member actually administered the GED skin shocks. This uncertainty as to how and by whom GED punishment was administered during the home visit raises questions regarding the appropriateness of making the device available to families where documentation of implementation does not occur. Moreover, there are specific requirements imposed by the Court Order that require JRC to report to the Court Monitor when more than 50 skin shock aversives are delivered to a student in a 24 hour period and when the student receives 250 skin shocks in seven days. The lack of specific data regarding the home use of the GED suggests that the court mandate for reporting may be compromised.
• JRC's practice of providing the shock device to families and allowing newly hired staff with little to no training and information on a student to administer the GED appears to be in direct violation of the FDA required safety precautions on the use of the device.
• In one classroom it was observed that a new staff member was briefly informed that his role in the room was to monitor 1:1 student S and second party verification was not required before administering the GED. The new staff person was handed the SLED (GED transmitter) and verbally given direction and instruction in when to administer the GED. As the instructing staff person was departing, she also informed the new staff that student S is deaf.

One student wearing the GED who was interviewed displayed insight into his behaviors and related replacement and coping behaviors he taught himself (writing in a journal; writing poetry). These abilities indicate the possibility that less aversive and intrusive interventions could be attempted systematically with this student.
Findings: JRC employs a general use of Level III aversive behavioral interventions to students for behaviors that are not aggressive, health dangerous or destructive, such as nagging, swearing and failing to maintain a neat appearance.
• Many of the students observed at JRC were not exhibiting self-abusive/mutilating behaviors, and their IEPs had no indication that these behaviors existed. However, they were still subject to Level III aversive interventions, including use of the GED device. The review of NYS students’ records revealed that Level III interventions are
used for behaviors including ‘refuse to follow staff directions’, ’failure to maintain a neat appearance’, ‘stopping work for more than 10 seconds’, ‘interrupting others’, ‘nagging’, ‘whispering and/or moving conversation away from staff’, ‘slouch in chair’, as well as more intensive behaviors such as physical aggression toward others, property destruction and attempts to hurt/injure self.

A higher functioning teenage student was observed sneezing in class. She covered her face and called out for a tissue. The teacher then indicated that that “calling out” was a target behavior that would result in her action being pinpointed as inappropriate (i.e., subject to aversive consequence). This example raises concerns that there might be little to no discrimination of acceptable, appropriate behaviors within a targeted behavior category subject to Level III aversive consequences by untrained or poorly supervised staff.

Despite the safety warning of the GED device that the GED should no be allowed to become wet or submerged in water, it was reported by JRC staff that for some students, the GED device remains on them while they take a bath or shower. Student records verified this and one student interviewed stated that she had been burned by the GED device while taking a shower. By this student’s report, a new staff person was not adequately trained to administer the GED-4 shock during the student’s shower, resulting in a burn to her skin where the device was attached.

JRC has a policy on modifying contingencies due to the special “pleading” of students. Part of the treatment program for students involves deliberately setting up unfair or mistaken directions or decelerative (application of a skin shock with a GED device) consequences for the students. The student is expected to handle these unfair situations successfully and not ‘plead’ or appeal to a psychologist or clinician regarding his/her treatment. In instances where the student “pleads” to the psychologist or clinician, there are consequences imposed on the student.

The use of camera monitoring allows for delayed punishment. In cases where the student did not receive the GED, the individual reviewing the video footage from earlier in the day reports to the psychologist, who then makes the determination that the GED should be applied long after the targeted behavior occurred. One NYS student reported of an instance when she had returned to her residence and fallen asleep. She was woken without explanation and told to stand. She was given a GED across her stomach, and then was informed that the reason for the punishment was a target behavior earlier that day for which she did not receive a GED.

It was reported by a JRC staff member that one of the BRL episodes involved holding a student’s face still while staff person went for his mouth with a pen or pencil threatening to stab him in the mouth while repeatedly yelling “YOU WANT TO EAT THIS?” The goal was to aversively treat the student’s target behavior of putting sharp objects in the mouth.

Many students spend their instructional day at individual computer terminals, performing the same instructional task over and over. The repetitive nature of the task was evident when the team visited classrooms and saw students repeatedly tapping unresponsive computer screens.

During the May 16-18 site visit, it was confirmed that the majority of staff serving as classroom teachers at JRC are not certified teachers. One crisis classroom teacher the team spoke to has a high school diploma and had acquired college credits through distance learning Internet courses.

A student interviewed stated that she had entered JRC at the age of 19 with the expectation that she would receive vocational training while she resolved her emotional and behavioral problems. She had not received any vocational training and still remained in the most restrictive settings offered by JRC. This student wept as she asked the team to bring her back to New York.

Findings: The privacy and dignity of students is compromised in the course of JRC’s program implementation.
• Video surveillance system monitoring includes most bathrooms and all bedrooms but no formal staff monitoring system is in place to ensure the privacy and dignity of students/consumers during intimate grooming/hygiene or personal sexual behavior (e.g., masturbation). For example, no procedures were in place to ensure staff was not observing opposite sex residents during showering.
• One NYS student’s behavior program states, “C will wear two GED devices. C will wear 3 spread, GED electrodes at all times and take a GED shower for her full self care.” This student, as are all students at JRC, is monitored through JRC’s video surveillance system and a staff person would monitor her in the shower.
• Students were observed as they arrived and departed from school. Almost all were restrained in some manner, some with metal ‘police’ handcuffs and leg restraints, as they boarded and exited the vehicles. Several students are transported in wheeled chairs that keep them in four-point restraint.

One student’s behavior plan indicated that the student is to be rewarded when he does not react to a staff member preparing to or administering the GED to another student, implying that this student may be having collateral effects when peers receive skin shock consequences.
• One student stated she felt depressed and fearful, stating very coherently her desire to leave the center. She is not permitted to initiate conversation with any member of the staff. She also expressed that she had no one to talk to about her feelings of depression and her desire to kill herself and told the interviewing team that she thought about killing herself everyday. Her greatest fear was that she would remain at JRC beyond her 21st birthday.