When a large service provider for people with developmental disabilities decided to move away from using restraint and seclusion, a new study finds safety improved and costs went down.

Over a 12-year period, restraints decreased 99 percent and seclusion was eliminated at the Virginia-based Grafton Integrated Health Network, which serves more than 3,200 people with intellectual, developmental and psychiatric disabilities in residential and community-based settings.

At the same time, the provider saw a 64 percent decline in client-induced staff injury and an estimated savings of $16 million in associated costs from overtime, turnover and workers’ compensation. Clients, meanwhile, were far more likely to achieve mastery in their goals.

The findings come from an analysis of the changes conducted by staffers at Grafton that was published online recently in the journal Advances in Neurodevelopmental Disorders.

“We knew there had to be a better way,” said Kim Sanders, executive vice president of Grafton and a co-author of the study. “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.”

As of 2003, Grafton logged 6,646 incidents of restraint and seclusion. The following year, the organization instituted new protocols using a trauma-informed approach. Staff were taught to be flexible, reassure clients, ask questions, employ kindness and compassion and move away from a mindset of having the “upper hand.”

The methods were deployed across a wide range of placements catering to those with intellectual and developmental disabilities ages 6 to 22. Clients included those in psychiatric residential treatment, community-based group homes, education settings, outpatient services, early intervention services and an applied behavior analysis program.

“Our system shows that you can eliminate the use of restraint and seclusion without compromising safety, as long as caregivers are properly trained,” Sanders said. “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.”

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