By Using Comfort versus Control, Grafton Integrated Health Network
Reduces Use of Restraint by 99% and Eliminates Seclusion Entirely
A new longitudinal study, just released in the journal Advances in Neurodevelopmental Disorders, illustrates one behavioral healthcare facility’s ability to dramatically reduce physical restraint and completely eliminate seclusion by shifting to an approach of comfort versus control. The article, “Evaluation of a Program Model for Minimizing Restraint and Seclusion,” follows the sharp decline of the use of restraint and seclusion from 2004 – 2016 at Grafton Integrated Health Network, a Virginia-based facility that serves at-risk and high-risk clients (both children and adults) with intellectual, developmental, and psychiatric disabilities.
The study evaluated all of Grafton’s organizational operations, which included more than 750 employees and 3,244 clients in 2016. In the year before the program began (2003), there were 6,646 incidents of restraint and seclusion.
“We knew there had to be a better way,” said Kim Sanders, co-author of the study and Executive Vice President of Grafton. “Not only were these techniques harmful to both our clients and our staff, they simply didn’t work. In fact, consistent with the data, we saw that using restraint and seclusion was just reinforcing and maintaining aggression and violence. We decided to create a new model for addressing challenging behavior which was grounded in respect for all involved.”
A comfort versus control mindset was introduced as part of a trauma-informed approach. This method minimizes the chance for everyday operations to traumatize or re-traumatize clients during service delivery. The Grafton philosophy taught response blocking, promoted an understanding of behavioral intent and client needs, and encouraged the development of creative solutions as meaningful alternatives to restraint and seclusion. This cultural shift asked employees to reassure clients, ask questions instead of making assumptions, be flexible, let go of the need to have the “upper hand,” and treat others with kindness and compassion.
The results were dramatic:
- A 99% decrease in restraint frequency
- A 100% reduction seclusion (from 253 cases in 2003 to 0 in 2015 and 2016)
- A 97% decrease in staff injury from a restraint
- A 64% decrease in client-induced staff injury
- An increase in client goal mastery 133% from 2003 to 2016
- A savings of over $16 million in lost time expenses, turnover costs, and workers’ compensation policy costs
“This model of care not only has an impact on restraint and seclusion incident rates but has created a profound culture shift across the entire organization,” said James Stewart, Grafton’s Chief Executive Officer. “Our approach is rooted in the belief that the use of physical restraints is not only unnecessary, but also unproductive and that all intervention — educational and behavioral — should be built on an approach of comfort versus control.”
Now, through its Ukeru Systems division, Grafton has trained more than 100 other organizations on the conceptual and technical elements of the program. Ukeru provides support and capacity building to caregivers, teachers, parents and others, helping them to implement the model in their own environment.
“Our system shows that you can eliminate the use of restraint and seclusion without compromising safety, as long as caregivers are properly trained,” said Sanders, who is also the President of Ukeru. “Ultimately, it is about receiving, engaging, sensing, feeling and responding to what someone is trying to communicate to us through their actions while maintaining the safety of all those involved.”