The Autism Society Event and Education Recordings Archive

In the United States, moderate to severe aggression has historically been managed through the use of mechanical restraint, physical restraint and seclusion. This practice is about to change. With pending legislation (which has passed in the House), the Keeping All Students Safe Act (formerly called the Preventing Harmful Restraint and Seclusion in Schools Act [H. R. 4247]), introduced by U.S. Representatives George Miller (D-CA) and Cathy McMorris Rodgers (R-WA), many will be challenged to find alternatives to the use of physical restraint and seclusion. It has been said that “you do what you know, until you know something better.” Often, it takes a mandate of some kind to force us to be open to finding that “something better.” In 2004, Grafton’s CEO issued a mandate to reduce physical restraints without increasing client-induced employee injuries and clients' injuries. It was the push that we needed.

Grafton has served individuals with autism and other developmental disabilities accompanied by challenging behaviors for over 50 years. Throughout that time, we have used various de-escalation strategies. When other tools failed, however, physical restraint was called upon to maintain safety. For example, in one month in 2003, we had 260 physical restraints for a total duration of 3,800 minutes.

Over the course of five years, Grafton has succeeded in substantially decreasing the use of physical restraints in all three of its Regions. In the Winchester Region in fiscal year (FY) 2004, there were 2,151 restraints; in FY 2005, there were 1,397; in FY 2006, there were 348; in FY 2007, there were 53; in FY 2008, there were 8; and in FY 2009, there were only 6. The population of the individuals we serve has not changed, and our census has remained stable.

The presenters will begin this session by taking participants through the initial development of the initiative to reduce the use of physical restraint in Grafton’s Winchester facility. The model used will be reviewed and compared to other published literature and practices.

Case studies paired with data depicting clients with severe behavioral challenges will be used to guide participants through the treatment planning and implementation process. One case study, in particular, will illustrate strategies used that promote a culture of comfort and security. It is the story of a young man who came from a facility that used extreme, aversive techniques(shock treatment). At Grafton, this same young man is treated with dignity and respect, with a far more positive outcome. The discussion will cover the critical decisions made leading up to his enrollment at Grafton; how the initial treatment plan was developed; the specific training of direct support professionals; obstacles that were overcome; and, ultimately, how the individual’s life was changed.

The session will conclude with an emphasis on sustaining success. It is not uncommon in any organization for an initiative to be introduced and to fairly quickly see positive results. However, the results lessen as enthusiasm and data analysis weaken. In the Winchester Region of Grafton School, the initial success of this initiative has led to an overall change in culture. There is a new way of thinking, a new way of viewing challenging behavior and a solid process for treatment planning, all of which resulted in the sustained efficacy of this program.

The primary lesson to be learned from this session is that physical restraint is not the only answer. In fact, it is not even a viable option any longer. Other alternatives are just as effective and much safer. The success achieved during this initiative can be easily replicated at other schools and facilities serving individuals with autism, and we want to help others in the field to take this information back to their organizations, minimizing the use of physical restraint elsewhere. Again, this session is now more relevant than ever due to the  Keeping All Students Safe Act (H.R. 4247). Others can leave this session and be out in front with new standards.