Punishment for grown ups

This month the UK Society for Behaviour Analysis published their position statement on punishment. This is hugely needed in the world of Applied Behaviour Analysis. ABA does not standardly use punishment despite many common misconceptions. The biggest problem we have is the word punishment means something completely different in behavioural science terms to what it might be seen to mean in everyday language. My plan here is to explain some of these differences, which will lead to an insight into PBS4’s position on punishment and other related terminology. But this blog comes with a huge health warning, hence it is for grown ups. Punishment is a very emotive topic. I ask readers to read with an open mind before jumping to emotive reactions.

There are four terms which get commonly used interchangeably. All have different meanings. These are: abuse, restraint (inc all restrictive practices), aversives, and punishment. Although these may be seen as one and the same they are each very different. Punishment can be used that isn’t restrictive, aversives may be used that are not abusive etc etc. I will try and add clarity to what each term means and then offer a position on this.

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Abuse

Abuse is when harm is caused to a person. This may be physical, psychological, sexual, financial, neglect, or institutional.

Everyone is opposed to abuse. No one advocates for abusing people. Sometimes abuse can be unintentional and an open culture can help identify unintentional abuse at the earliest possible sign. All abuse should be reported to the appropriate authorities and vulnerable people should receive support that is governed in a way so as to protect them from abuse as much as possible.

Restraint

Restraint can include physical, mechanical, chemical, and environmental. The best definition I have heard is “preventing someone from doing something they want to do”. It may be that they want to smash your head to the back of next week – if we choose to restrain them we are preventing them from doing what they want to do.

Restraint has received a lot of bad press – and rightly so. For some it is a default, or the only option they have in responding to aggression. Some restrictive approaches come with life threatening risks, such as prone restraint. And restraint can be used abusively, intentionally or unintentionally. The use of restraint also has no predictable value on the increase or decrease of future behaviours. It could go either way. But, sometimes using restraint is part of a responsible service provision. When done right it can prevent people from being harmed or harming others.

Restraint should only by used when TINA is here – There Is No Alternative. It should be the least restrictive approach used and for the least amount of time. All restrictions need to be openly and honestly reported – not fluffed up with terms like “positive handling”. Call a spade a spade. It needs monitoring to check the use of restraint is reducing over time.

Aversives

Aversives are things that people don’t like. Although there will be some commonalities, we will all have our own preferences and tolerances. For example, we would all find putting our hands in a fire very aversive. Some people like hugs, others find them uncomfortable and awkward.

We all have aversives in our lives – monday mornings; people saying no; rain; traffic jams; bank balances; fines; social disapproval; eating vegetables; tiredness… I could go on. A life without aversives is no life at all. As much as we grumble about them, if we didnt have them we would just find new aversives.

There is a difference between mild aversives and strong aversives. We should support people with learning disabilities to avoid strong aversives as much as possible. Purposefully presenting strong aversives is abusive.

Learning successful strategies to cope with and avoid mild aversives is what makes us successful people. People with disabilities in learning will struggle to learn these coping and avoidance strategies and may use unconventional (challenging) alternatives. It is giving people a fake life to remove all aversives from a persons life. It is a failure on our behalf if we don’t attempt to teach people to cope and avoid these aversives successfully.

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Punishment

Punishment, in behavioural terms, only means the reduction of future incidences of a behaviour. The only way you can find out if something you have done has been punishing is to monitor its effect and see if it has reduced that behaviour. Doing something that doesn’t reduce behaviour repeatedly is likely to be abusive.

People with learning disabilities can often struggle to learn from aversives so presenting an aversive with the intention of reducing a behaviour may not be successful. You could just be repeatedly giving the person what they don’t like and they may not see that they can control this by reducing the behaviour that precedes it.

More importantly, people with learning disabilities often have a very limited repertoire of behaviours to express their wants, needs, desires, and emotions. What right do we have to further reduce their repertoire by saying “we find that behaviour challenging so we are going to reduce it”?

Positive Behaviour Support aims to understand the function of a behaviour and then help the person increase the ways they can achieve this. This may make behaviours we find challenging redundant as people then have quicker, more effective ways of getting what they want.

Our position is┬áto oppose the use of punishment. All behaviour is expressive so why would we want to silence people? However, there might be severe exceptional circumstances, such as if a behaviour is very severe – posing risk to life, serious injury, breakdown of the home – then there may be reason to consider a punishment intervention. It should only be used with multi-agency and family agreement. It should be reviewed to check it is not abusive. As with restrictions, it should be checked this is done for the least restrictive/least aversive/shortest time possible. It should be overseen by professionals and closely monitored to check that the behaviour is reducing.

Conclusion

Our default position is to identify constructive approaches. We will understand why a behaviour is happening, respect that this is a communication from the person, and help the person to increase their repertoire of behaviours that they have to achieve this function. As a natural side effect, this is often the disruptive technology that makes challenging behaviours redundant.

Our approach is not to use punishment. In really very exceptional circumstances, if there is no alternative, if all involved have agreed, if it has been fully assessed and planned, and if it has been agreed to be the only approach available at this time then a punishment intervention may be used. This would never involve the use of strong aversives and must almays be stopped as soon as possible – which if it is a genuine punishment will happen.

We recognise the strong aversives in peoples lives and where possible avoid these. Mild aversives are part of life and our default position is to take responsibility for enabling people to learn ways of coping with these.

Abuse is never tolerated. When it happens unintentionally steps to protect the person must be instantly put in place. It is essential that learning occurs to avoid this happening again.

jen rolos

Positive Behaviour Support, with the science of Applied Behaviour Analysis, enables people to hold on to their spoons without experiencing punishment

 

 

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Gagged by red tape, faceless, dehumanised

Here is a guest blog from Jen. A mum describing how the system and society is letting families with learning disabilities down. Does this sound familiar to you? Have you had better experiences? Either way we would like to hear from you. Please comment or send us a blog you would like us to share.

By talking about what works and what doesn’t we might start getting it right more often. If we keep silencing when things go wrong the pressure continues to build until things erupt. Over to Jen…

When our children are first diagnosed with a learning disability people put us on a pedestal and tell us how wonderful we are, a hero, a warrior. They couldn’t do it so we must be an angel chosen by God.

This does not last long and the reality of a society, a system that when our children grow the stereotype changes and we as parents become irrelevant and irrational.

We are gagged by red tape. Faceless and dehumanised. Our feelings and experience don’t count. We are weighed down by societies attitudes and assumptions. Our energy depletes as we try to be heard, to bridge the gap. Our lives shatter never to be the same.

And why? Because we believe in and love our children and just want the same basic human rights as everyone else.

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Our children are more than pound signs in your bank accounts. We are more than ticks in your boxes. We are more than the idealistic words on your websites, part of strategic person centered plans and we are more than stereotypes and labels

Parents are the thread that runs though our children’s lives encompassing knowledge and experience of years of trial and error. Years of observing, learning and growing. Hours and hours of research. Years of sacrifice of multiple recurring losses of family, friends, careers and self. All to give our child the best. As any parent wants to.

We have the answers that can save time, grief and money.

We don’t want pity. We don’t want living by indifference. We want real working in partnership. Not tokenism. Real consultancy. Real listening. Real action. Real quality of life. More than just care. Real honesty. If you can’t give this…say so.

Get creative with the cuts by using one of your most valuable yet free assets.

I hear excuses that I am in the minority that parents don’t want this. They do but many are too frightened to speak out. To scared to fill out your questionnaires your surveys. To scared to be honest with you for a real fear of what will happen without retribution. Parents have learnt to be afraid the hard way.

Threats are real. On going. Institutionalisation is real and on going. Conformity is real and on going. Gagging parents is real. Wearing them down. Belittling. Fobbing off. Lying to and covering up. Is on going.

Today’s systemic injustice is rife. It is allowed. It is even praised as people trying their best. And yet people die preventable deaths.

Family carers should not be afraid to want to have a positive part in improving services in the care system.

All this causes years of mostly hidden chronic grief and pain. Soul destroying.

On a battlefield that shouldn’t even be there.
I am so tired I don’t want to wake up in the morning and my son is alive.
But for him I hope I can keep going.

Jen
Mum