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Well over a decade ago, Grafton Integrated Health Network implemented an organization-wide initiative to minimize and, where possible, eliminate the use of coercive techniques such as restraint and seclusion. When the initiative began, the organization had over 1,500 seclusions and almost 7,000 restraints per year for 220 individuals. Today, while serving over 250 highly acute and complex consumers each day, Grafton has achieved a 99.8% reduction in the use of restraint and 100% reduction in the use of seclusion. It has also dramatically reduced the number of injuries to clients and staff, decreased staff turnover, and significantly increased the rate of treatment goals mastered across the organization. Through its Ukeru (Japanese for “receive”) division — currently used in 22 states and more than 88 private day and residential programs, private and public schools, psychiatric hospitals and forensic units — Grafton shares this expertise with other organizations. Ukeru provides training on the conceptual ideas — such as trauma informed care and conflict resolution — as well as the physical techniques that minimize the need for restraints and seclusion. It also provides organizational assessments, training, change management support and capacity building to assist organizations in implementing the model in their own environment.
Grafton was faced with the fact that restraint and seclusion were being overused. What does an organization do when its primary tool isn’t working? Find something better. When it became clear that nothing better existed, the team decided to create the solution itself. They set out to develop a system that supports even individuals with the most challenging behaviors. What came to be known as Ukeru is grounded in two distinct, evidenced-based structures – applied behavior analysis (ABA) and trauma informed approaches. Infused with a philosophy of comfort vs. control, Ukeru builds preventative strategies for behaviors of concern. Grafton also based its solution in reality; sometimes even the right words and strategies don’t work. For those situations, the team developed a system of blocking (including soft, cushioned equipment designed by the very staff who use it everyday) that replaced restraint and kept everyone safe. Ukeru equipment is officially patented.
Ukeru has undertaken a concerted effort to reach a diverse audience: – Providing consultations and trainings as far afield as Australia, and in numerous domestic provider organizations. – Building a distribution list of nearly 20,000 behavioral healthcare organizations, public and private schools and psychiatric facilities, among other relevant stakeholders; – Creating a quarterly webinar to highlight the need for minimizing restraints and seclusions as well as results achieved from using a trauma informed approach; – Regularly presenting at national and international conferences; – Participating in the creation of informational videos with Georgetown University; – Publishing a quarterly newsletter with information and resources; – Earning more than 17 articles in both trade and consumer outlets; – Establishing a presence on social media platforms including Facebook and Twitter; – Creating multiple data visualizations highlighting the impact of restraints and seclusions; – Conducting robust outreach to organizations struggling with crisis management directly.
Ukeru results can be replicated with appropriate training as proven by its successful implementation at its own geographically disparate residential site regions, and in external providers that have implemented the technique in their facilities. Such facilities include AltaPointe Health Systems (AL), Autism Services, Inc. (NY), California DDS, Texas DADS, as well as various public school districts. Ukeru believes that stand-alone “crisis intervention programs” are often unsuccessful because they are not embedded within an organizational culture and structure that supports them. To address this challenge, Ukeru utilizes an innovative organizational leadership, communication, and governance structure built on seven pillars: leadership, communication, training, measurement, debriefing, alternative solutions and therapeutic treatment programs. This, combined with its crisis response planning, represents a potent force to improve safety and outcomes. Ukeru has gained the attention from, and often partners with, advocacy organizations including Autism Society, TASH, Stop Seclusion and Restraint, and several managed care organizations.
Having successfully implemented Ukeru at its three geographically disparate residential site regions, Grafton knew such results could be replicated. To support organizations in achieving similar results, Ukeru provides training on the conceptual ideas — such as trauma informed care and conflict resolution — as well as the physical techniques that minimize the need for restraints and seclusion. Conceptual training is provided on: • Verbal and nonverbal communication; • Converting/diverting aggressive behavior; • Building an environment of comfort rather than control; • Taking into account the high prevalence of traumatic experiences. Physical techniques are taught by including the effective use of protective equipment to keep both the caregiver and client safe. Access to training videos, which can be referred back to at any time, is also provided. Ukeru’s model is built specifically to create in-house champions who are able to lead the effort of lasting cultural change within their organization.
Since implementing Ukeru, Grafton has: – Significantly reduced the use of restraint and seclusion as well as client and employee injuries and staff turnover; – Increased the rate of treatment goals mastered across the organization; – Substantially decreased workers’ compensation policy costs and employee turnover for a total return on investment of over $17 million; – Developed custom-made, soft, cushioned blocking tools that keep both professionals and those in their care safe and comfortable. Four design patents have been issued to several of these products — the Flex Shield, Arm Shield and Curved Shield. The program has also received honors for its trauma-informed crisis management technique including the Negley President’s Award for Excellence in Risk Management Practices, the National Council Impact Award, and recognition from the Substance Abuse Mental Health Services Administration for clinical best practices in restraint and seclusion reduction.