Statement from the Judge Rotenberg Educational Center:        The Judge Rotenberg Educational Center (JRC) is a residential program providing intensive behavioral treatment and educational/vocational services to 275 children and adults from across the country who engage in the most dangerous aggressive behaviors (“AB”) and self-injurious behaviors (“SIB”) across all diagnosis populations, including people with major mental illness, autism, and developmental disabilities. Prior to their admission, JRC clients have caused lifethreatening injury and permanent disfigurement to themselves and others through their uncontrollable behaviors, such as head banging, eye gouging, tearing their own flesh, biting off body parts, pulling out their own adult teeth, punching their fists through glass windows, jumping out of windows, and violently attacking family members, teachers, staff and others with punches, kicks, and bites. JRC has treated clients from more than 20 states who have come to JRC from some of the best treatment facilities in the nation where they could not be effectively treated with other forms of treatment, including, but not limited to, psychotherapy, counseling, Positive Behavior Supports, restraints, seclusion, time out, and massive dosages and combinations of powerful anti-psychotic medications, which have dangerous and sometimes permanent side-effects, including death The current clients come from the following states: Alaska, Massachusetts, Connecticut, New Hampshire, Rhode Island, Maine, New Jersey, New York, Delaware, Maryland, DC, Virginia, Illinois, California, Wisconsin and the Virgin Islands JRC’s staff includes Massachusetts Licensed Applied Behavior Analysts, Board Certified Behavior Analysts, psychologists, medical doctors, psychiatrists, nurses, special education teachers, occupational therapists, speech and language pathologists, physical therapists, social workers, and other licensed professionals. More than 80% of JRC’s clients are effectively treated with only JRC’s elaborate system of positive reinforcement that is individually designed to meet each client’s needs. A small percentage of JRC’s clients (approximately 47 / 17%), however, engage in such intractable, unpredictable, and dangerous AB and SIB that they require JRC to supplement their positive behavioral program with an aversive treatment for the harmful behaviors. JRC only uses a graduated electronic decelerator (GED) device, which applies a two second shock to the surface of the skin, with a client as a last resort after all other treatment options have been tried and failed; it must be approved by a Massachusetts Probate and Family Court (the “Court”). The Court process involves assigning an independent attorney to represent each individual client’s interest, and the attorney can request Court funds to hire an independent clinical expert to examine the client and carefully review the client’s treatment history and JRC’s proposed behavior modification treatment plan. The Court holds a hearing and rules on issues such as the client’s diagnosis, prior failed treatments, and whether aversive treatment is necessary to effectively treat the client’s severe behavior disorder. Individualized quarterly reports on the use of the GED for each client are sent to the Court, the independent attorney, the client’s parent/guardian, and the state agency that placed the client at JRC. The Court reviews each client’s aversive treatment annually to determine whether it remains effective and necessary and decides whether it should be    reauthorized. The Supreme Judicial Court of Massachusetts has affirmed the Court’s authority to approve aversive procedures such as contingent skin shock. See Judge Rotenberg Educ. Ctr., Inc. v. Commissioner of the Dep't of Mental Retardation (No. 1), 424 Mass. 430 (1997). All JRC clients receiving treatment with a GED device are thoroughly protected by comprehensive due process and consent requirements. The law requires written informed consent from the client or, if the client is not competent, a parent or guardian (who can withdraw consent at any time). Also required is a written behavior modification treatment plan detailing a treatment’s rationale, duration, conditions, and goals, as well as a detailed monitoring plan for evaluating the treatment’s efficacy, created and approved by a clinician with a doctoral-level degree and “a demonstrated history of experience and training in applied behavior analysis and behavioral treatment.” In addition, the plan must be approved by a Human Rights Committee (that includes a medical professional, legal professional, and clinician with expertise in developmental disabilities, mental illness, or applied behavior analysis), and by a Peer Review Committee (that includes a licensed psychologist and clinicians with expertise in the treatment of individuals with severe behavior disorders). The state agency that referred the client to JRC also must approve the treatment plan and incorporate it into the patient’s Individualized Service Plan/Individual Habilitation Plan. The plan must be reviewed by a physician who examines the client and confirms that there are no medical contraindications to the use of behavior modification treatment. Aversive interventions are widely accepted by professionals as necessary and effective treatment for seriously harmful, treatment-refractory, maladaptive behaviors. For example, the Professional and Ethical Compliance Code for Behavior Analysts published by the Behavior Analyst Certification Board (the “BACB”), the international credentialing and standards organization for behavior analysts, states that the use of aversive interventions, such as the GED devices, to treat severe behaviors is an accepted form of treatment. Like the BACB, the Association for Behavior Analysis International (the “ABAI”), the preeminent international professional organization for behavior analysts, issues guidance on the use of aversives and recognizes that a client has a right to effective treatment, including aversive interventions. Similarly, Division 33 (Intellectual & Developmental Disabilities / Autism Spectrum Disorder) of the American Psychological Association agrees that aversive interventions, including contingent electric shock therapy, are appropriate “in instances in which there is an immediate physical danger to self or others, or there may be permanent sensory o[r] other physical impairment, or the client may be prevented from receiving necessary medical, surgical, or emergency medical services, or the frequency or intensity of the problematic behavior prevents adequate participation in normal activities appropriate for the individual’s circumstances and personal goals”. All classrooms, work activities centers and residences are monitored from a central location in JRC’s administration building twenty-four hours per day, seven days per week by means of a digital video monitoring system and footage of every GED application is reviewed In addition, every targeted harmful behavior and application of the GED device is charted and made available to the client’s treating clinician, the parents/guardians and the state agency, enabling clinicians, parents/guardians and agency officials to see the number of GED applications administered each day, for what behaviors, and the progress the client is making.     Positive programming continues for all clients who are treated with the GED device. For more than 25 years, JRC has been specially certified by the Massachusetts Department of Developmental Services (“MA DDS”) every two years, confirming it has the ability to safely provide aversive treatment to its clients. MA DDS evaluates JRC as part of this certification and JRC has been continuously certified by MA DDS, proving its ability to safely offer GED treatment to its clients. Every application of an aversive is documented on the student’s daily recording sheet and transferred to daily, weekly and monthly charts which are immediately available to the student’s clinician (through a database that is available through networked software) and to the parents and placing agency (through a Parent/Agency Website), enabling clinicians, parents and agency officials to know exactly how many applications are made, for what behaviors, and with what results. The use of electronic stimulation devices (ESDs) causes a rapid deceleration of students’’ dangerous and disruptive behaviors and JRC’s educational program teaches these students to replace their problematic behaviors with positive behaviors such as social, recreational, and educational activities. On average, current students receive less than one (two second) GED application per week. Moreover, each student has a plan in place whereby the use of the GED will be phased out or reduced. At JRC, those receiving treatment with ESDs exhibit dramatic reductions in their self-injurious and aggressive behaviors. Further, contrary to reports by uninvolved organizations, the devices are safe. Every application of the devices is tracked and every student continuously monitored. There have been no skin burns caused by these devices and no evidence of long term side effects. Students are evaluated by clinical staff every time a shock is administered and patients undergo weekly routine physical and mental health evaluations by attending clinicians and physicians. JRC’s experience is that in this highly specific patient population, there is limited risk presented by use of these devices and incredible benefit that can be summarized as a dramatically improved quality of life. The students are generally free of restraint and psychotropic medications, and free of injuries, thereby allowing them to receive an education, living skills training, job training, integration into the community and a quality of life that was not possible before use of these devices as part of an intensive ABA treatment plan. In a number of cases, treatment with the GED has allowed them to undergo treatment of other medical conditions that were not previously possible due to extreme self-injurious behavior.  JRC has presented hundreds of peer-reviewed articles on the safe and effective use of contingent skin shock, several of which are specific to the treatment success at JRC.  The long history of use of ESDs at JRC, particularly for a refractive population, demonstrates that these devices are a safe treatment option for use in extreme cases where students are a danger to themselves and others and where all other treatment options have failed. The benefits of using the devices strongly outweighs any potential risks. The safety and efficacy data as well as the findings of the Massachusetts courts, provide sufficient evidence to support the positive clinical benefit of the devices and risk/benefit profile for this population.