Grafton is a Virginia-based nonprofit behavioral healthcare facility that manages private schools for individuals with behavioral challenges. Kim Sanders has worked there for 30 years. Grafton’s policy on the use of seclusion and restraint has changed dramatically over the last 15 years.

“Our toolbox was full of restraint and seclusion. That was sort of the go-to technique that we used,” Sanders explains. She says that in 2003, the school served about 220 children and adults. But Grafton had more than 6,600 uses of restraint and about 1,500 instances of seclusion.

“We were so busy managing behavioral issues that our teachers or direct care staff, they really didn’t have the opportunity or the time to teach.”Sanders says.

“That affected our staff turnover negatively, we had lots of staff injuries, and of course that equates to not the very best quality of care,” Sanders says. “We were so busy managing behavioral issues that our teachers or direct care staff; they really didn’t have the opportunity or the time to teach.”

Then in December 2004, a 13-year-old autistic student died while restrained in their care. Sanders says they were already looking to change their policies before the death, but the need to change gained a sense of urgency following the death.

Now, the school uses an internally-designed and trauma-informed care approach that doesn’t involve seclusion or restraint.

“The whole idea is when someone is at their worst, we need to be at our best,” Sanders says.

Teachers are coached to empathize with students and think about what someone would need if they were having a bad day.

“Most people would say [they need] space, someone to be kind to me, maybe to read a book…go for a walk,” says Sanders. “No one is going to say, ‘Well actually, I need someone to hold me against my will or lock me in a room by myself.’ That’s not what any of us would want.”

Grafton’s method also requires teachers to learn about students’ patterns of behavior and learning styles to help individualize their approaches to education.

Sanders says in the last five years, the school has eliminated the use of seclusion and decreased the used of restraint by 99.8 percent.

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