The Autism Society Event and Education Recordings Archive

Safety is a fundamental right and an essential component for the attainment of optimal health and business outcomes for individuals and organizations.  The use of restraint and seclusion negatively impacts an individual’s physical and emotional safety but also the physical and emotional safety of employees providing the treatment/services/education.  These factors combined result in decreased quality of care, lower job satisfaction, and negative financial effects for organizations.

   Grafton Integrated Health Network, a private, not-for profit behavioral healthcare facility serving individuals across the lifespan with co-occurring intellectual, developmental and psychiatric disabilities in schools, group homes, outpatient, and psychiatric treatment facilities implemented an innovative plan to minimize the use of restraint and seclusion.  As an organization, Grafton accepted the notion that the use of restraint and seclusion were treatment failures and it was possible to manage emergency situations without the use of such methods.

 The results included:

• Improved client treatment and programming;
• Reduced physical restraints and seclusions (to include total elimination of

              seclusion across the organization and elimination of physical restraint in the

              largest region);

• Reduced employee and client injuries; and
• Countless unanticipated emotional and fiscal benefits to the organization.

      Ultimately, Grafton’s approach made a significant impact on the way the organization

serves those in care and attracted the attention of healthcare providers on a national and

international level.  Grafton’s journey to minimize the use of restraint and seclusion began with a

mandate issued by CEO Jim Gaynor in the summer of 2004:  Minimize the use of physical

restraint and seclusion without increasing employee or client injuries.  A seven gear model was

 implemented to minimize restraint and seclusion.  The seven gears utilized in Grafton’s

minimization of restraint and seclusion model were:  Leadership, Communication, Training,

Alternative Solutions, Therapeutic Treatment Planning, Debriefing, and Measurement.

        There were numerous lessons learned during the implementation of Grafton’s

minimization of restraint and seclusion model.  One lesson that will be highlighted was the

 realization that restrictive practices often result from fear and/or panic.  An innovative

intervention called Ukeru was introduced to employees that provided an alternative physical

technique to keep everyone safe while enhancing an employee’s confidence and patience.

Another lesson learned was the importance of providing trauma informed approaches, starting

with awareness and training.  During this presentation, the lessons learned will be discussed in a

detail in a manner that is engaging and inspiring.  

         Over Grafton’s fifty year history, various de-escalation strategies have been utilized.

As with so many of its peers in the industry, when all else failed, physical restraint and seclusion

were utilized to maintain safety.  Now, after several years systematically minimizing the use of

physical restraints and seclusion, Grafton has had a 97.6 percent reduction in physical restraints,

60.3 percent reduction in client-related employee injuries, 94.4 percent reduction in employee

injuries related to a restraint, and a 41.4 percent reduction in workers compensation policy costs.  

            The lessons that this industry leader learned can help other organizations/systems/schools across the country and the world keep individuals and employees safe while providing effective treatment/education and financial responsibility.