The good, the bad, and the creepy

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Many of the people reading this post are doing so out of sheer curiosity for what I saw at an infamous school that I interviewed at last week. Since I haven't secured employment yet, I decided to not name the school outright. To be quite honest, I probably wouldn't accept a job offer from them, but I don't want to burn any bridges in case my back ends up against a wall and the student loan folks are knocking on my door.

For those of you who aren't up-to-speed, the school in question is a private facility that serves a population ranging from the developmentally delayed to the criminal. Students end up at this school because of severe behavior problems. And for those of you who aren't in the field, severe behavior problems in the ABA world means life-threatening. Like, a kid hitting their head so hard with whatever they can get their hands on that they detach their own retinas. Like, a grown woman who can hardly speak, but has bitten off her therapist's ear. Like, a teenager with a defiance disorder that shattered someone's pelvis at his private boarding school. They all end up at this place as a last resort. Which, in my mind, helps to justify some of the procedures used.

This school uses contingent shock to suppress behavior in certain cases.

A lot of people have a hard time wrapping their head around that. I guess I've been completely desensitized to the idea, having read countless research articles while I was in school about contingent shock used in order to suppress self-injury. The thing is, most shock therapy was left in the last millennium. I always think about it in the context of stuffy, black-and-white research conducted at Johns Hopkins by people with really fashionable hairdos. The fact that it's happening on a daily basis within a reasonable commute from my house is pretty amazing. And apparently it's amazing to all of America. The school is constantly in the news for their use of shock, and never in a positive light. Recently, there was a big hullabaloo in the news about a student being shocked for an unethically long period of time. Now, I am certainly not trying to downplay inhumane treatment. However, with the sensationalism of the media, it's hard to know what's true and what is blown out of proportion. I believe that in certain rare cases, shock is not only ethical and humane, but the only thing that can save a person's life. However, I also know how uncertain that terrain is. How do you know?

Regardless, I chose to accept an interview at the school, half out of desperation and half out of curiosity. The school offers a ridiculously inflated salary due to their controversy and the difficulty they have in finding quality employees, much less getting them to be loyal to the company and continue their employment for any period of time. And with my contract at my current place of employment ending in less than a week, I really need to find the next step in my career path. So I'm not saying "no" to anyone. With an interview came the added perk of a peek into this bizarre world. Plus, I try not to pass judgement on anything unless I've examined it more carefully. Here's what I saw, broken down systematically:

The good:
-The school boasts a near-zero expulsion rate. They also claim to not turn away just about anyone. The woman who interviewed me told me about students who were in holding cells at Rikers Island. It's pretty wonderful that the individuals with no where else to go can find a placement. You have to wonder, though, who are the ones that are turned away? She mentioned that they aren't equipped to admit sex-offenders or murderers.
-The school and residences have amazing amenities. Students not only have a literal wonderland available to them at the school, but their homes have pools, swing sets, TVs, etc. That's better than my house...
-The students receive a high level of personal attention. They're staffed 2-to-1 or higher (2+ staff to each student,) and there are several layers of clinicians and case managers over them ensuring their safety.
-The school uses ABA and focuses on antecedent management and positive programming for their students. While I wasn't invited to see any classrooms, it was quite clear to me that students are almost entirely using contingency contracts with reinforcement systems that approach reinforcement that would be available in the real world.
-The variety of positive reinforcement opportunities is actually astounding. The literal wonderland that I mentioned? It mostly goes under "the creepy," but the rewards offered to students for good behavior appear to be highly, insanely, monumentally motivating. They have an entire room that is a gigantic ball pit. They have an arcade. They have a movie theater. All right there for students who can hold it together.
-According to my interviewer, students won't receive any contingent shock for roughly a year after they arrive at the school. If a student's behavior seems to warrant shock, she said, they try every single trick in the book before they resort to aversives. Plus, there is an extensive process that they have to go through to be granted permission to use aversives.
-The school has a systematic transition program in place to promote independence in students that are gearing up to leave. That's important, because even if someone isn't smashing cheekbones any more, being thrown out in the real world can be frustrating and confusing, and behaviors can re-emerge.
-There is some community involvement, and students in the more independent and transitional phases are able to have jobs on the outside.
-The school clearly has an insane amount of cash money. The facilities, the opportunities, the salaries...

The bad:
-Even with all of that cheddar in the school's bank account, my interviewer admitted rather sheepishly when I asked about transitioning students back to the real world that they periodically lose students due to funding running out. I mean, seriously? If you have all that money to build arcades with flashing lights and to pay those staggering salaries, shouldn't you have a fund in place for continued programming when students aren't ready to "graduate?" It just doesn't seem right to me that you would cut someone loose like that, after they have clearly demonstrated a serious need.
-Nothing about life at this school is real. I mean, when I go to work every day, regardless of how well-behaved I am, I don't get to then go play in an arcade on-site and watch a movie and skip down a yellow-brick road. More on that later, but it just isn't real. When I asked about that, about how reinforcement was just too different from real-life contingencies and that life isn't nearly as reinforcing as they make it, she said that they have levels of independence that they work students through, which correspond to more realistic contingencies. If I was already there, and someone was bankrolling me, I would flip out periodically just to get to stay in that warm, fuzzy, technicolor land of magic and marvel. I would never want to leave.
-Even with all the media attention they get, my interviewer still couldn't tell me what safeguards are in place to ensure ethical treatment of the students that receive contingent shock. Like, nothing. She gave me literally nothing. So, what do they do?
-She was also vague when I asked what assessment procedures were used to determine the function of these behaviors. She kind of waved her hand and said, "oh, we do functional assessments." Great, but you need to tell me exactly how you determine the function of a behavior before you're zapping someone. I need to feel pretty confident that that was the right choice for that human being.
-Work schedules are round-the-clock. I know that someone has to be there for crisis control, but the pointed to her own pager and phone and said, "everyone here gets a pager and phone, and you're on-call 24/7. I've gotten phone calls for run-aways at 3:30am and left my house to look for them." That does not sound conducive to job satisfaction, much less high-quality work. Shouldn't you be paying someone to be the night watchman?
-And no offense to her, but the interviewer looked absolutely haggard, like she hadn't slept in 10 years. Because she probably hadn't. I can't live that way.

The creepy:
-For some reason, the school has a penchant for life-sized dolls. Maybe I watch too many horror movies, but dolls creep me out in general. Especially realistic-looking dolls. Especially when they're life-sized. And everywhere. They were everywhere! In the special wonderland of reinforcement, they had dolls dressed up like all of the Wizard of Oz characters, hanging out on the yellow brick road under a magical apple tree. I'm sorry, but with a largely adolescent and adult population, that's just scary. And this is coming from me, who absolutely loves that movie. I'm not going to be able to watch it for quite a while now. Even the lobby has this doll of an old man in a tux sitting behind a piano, poised to play. Ew. Creepy. Creepy! It gave the whole place, which otherwise would have been cheery and welcoming, a repugnant aura.
-The school also had a set-up that felt a little bit like a secret society. For all that they showed me, there was a lot that I didn't see. And she talked about hiring BCBAs for the position I was interviewing for not because they do as much clinically, but they like to hire from within and keep it all in the family. So they start low-ranking positions as BCBAs so that when a clinician gets creeped out and quits, they can initiate a younger employee.
-The month-long training she alluded to and the very prevalent propaganda made me question how much of the employees' loyalty is earned, and how much is programmed into them. And I distrust any propaganda that tries to get my opinion through shock-value. I'm sorry, but I know how intense the students are. I don't want to see pre-op photographs of a bitten-off nose. I don't need to see someone's sinus cavity. I know what goes on.
-And like I mentioned, I saw everything shiny and glorious, but nothing real. I have no clue where they stash their classrooms or their cafeteria... it was a very odd "tour of the facility" to just see the corporate offices and wonderland. It makes you wonder, what are you hiding?

In conclusion: there are a lot of really good things about this place. There are a lot of really bad things about this place. There are a lot of downright creepy things about this place. Do I want a job there? No. The lifestyle would be horrible, and the controversy, upon examination, seems merited. But there was no blaring violation of human rights that I could see. There was nothing that made me sure that bad things were happening behind those walls. If it had come down to groceries or controvery and life-sized dolls, I might have had to get used to those dolls. Luckily, I have a job offer on the table and we're in salary negotiations...