Frequently Asked Questions

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• Statutes and regulations are outdated, confusing, uncoordinated, and protect some while others remain at risk.

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

What needs to be done to prevent their use? 

By advocates:

• 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

By agencies:

• 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