Frequently Asked Questions


What makes Grafton unique among its peers? And what are the costs for its services? The information below is intended to provide some initial details. We are happy to answer any further questions you may have.

What services does Grafton provide?

Grafton provides an integrated continuum of care — including education, early intervention, outpatient, residential and short-term stabilization services as well as career and technical training — helping clients thrive in a variety of settings. A detailed list of our services can be found here.




Is Grafton primarily a provider for children with Autism? Does it provide services for other ages, populations and challenges?

Though we are at the forefront in working with individuals on the Autism spectrum — and have worked with this population throughout the past six decades — we serve children, adolescents, and adults with a range of complex challenges.

Grafton welcomes the opportunity to work with the most at risk and vulnerable populations, many of whom have co-occurring diagnosis. With a long history of clinical experience and evidence-based data in behavioral health and intellectual/developmental disabilities, we are uniquely qualified to deliver improved outcomes for a many different mental health challenges.

What does Grafton do that makes it unique from its peers?

While many organizations focus on providing either behavioral healthcare or treating those with intellectual disabilities, Grafton has found that serving both populations improves outcomes for all. Teams serving individuals with intellectual and developmental disabilities are able to learn from those providing the latest psychotherapeutic approaches — and vice versa — deepening and broadening the available expertise. Further, our six decades of clinical practice, evidenced-based data and record of successful outcomes support this integrated approach

While “trauma-informed” has become a frequent buzzword in behavioral healthcare, Grafton is a true pioneer in the application of trauma-informed principles. For more than a decade, we have taken a trauma-informed approach with each client we serve by adhering to a philosophy of comfort vs. control:

  • Recognizing the pervasiveness of trauma – with a high likelihood of past trauma, it is critical to ensure adequate support for these experiences
  • Identifying and addressing trauma as early as possible
  • Understanding the connection between current behaviors and past trauma history
What do you mean by “Comfort vs. Control”?

We believe in helping our clients thrive in the least restrictive environment consistent with achieving the best outcome. Well over a decade ago, we implemented an organization-wide initiative to minimize and, where possible, eliminate the use of coercive techniques such as restraint and seclusion. Today, not only have we achieved a 99.8% reduction in the use of restraint and 100% reduction in the use of seclusion, we have dramatically reduced the number of injuries to clients and staff.

The rigor Grafton applies to measuring progress in clients’ plans of care, and in using the data gathered through this process to inform future treatment decisions, makes the organization unique among its peers. We support the recovery and well being of clients and families by:

  • Enhancing their quality of life
  • Reducing their referral behaviors, addressing their needs and building resilience
  • Restoring or improving their functional autonomy
  • Facilitating their integration into the community


What third-party credentials has Grafton received (e.g. licensing, accreditations, commissions, and/or associations that require standards and/or compliance requirements)?

Grafton is:

  • Licensed by the Virginia Department of Behavioral Health & Development Services for: outpatient services, residential service for children, programs for adults in Virginia and our psychiatric residential treatment facility
  • Licensed by the Virginia Department for Education for educational services
  • Accredited by AdvancEd for our Berryville residential treatment center and our three private day schools in Winchester and Richmond
  • Nationally accredited by CARF for outpatient and psychiatric residential treatment facilities
How does Grafton measure outcomes?

Grafton is committed to helping each individual served meet his/her individualized goals, promoting a successful transition to a less restrictive setting, as soon as possible and appropriate, within the individual’s home community.

The rigor Grafton applies to measuring progress in clients’ plans of care, and in using the data gathered through this process to inform future treatment decisions, makes the organization unique among its peers. We support the recovery and well being of clients and families by:

  • Enhancing their quality of life
  • Reducing their referral behaviors, addressing their needs and building resilience
  • Restoring or improving their functional autonomy
  • Facilitating their integration into the community

Over the past decade, we have successfully implemented a formal “Goal Mastery” initiative that seeks to assure objectives established for each individual are clearly defined, meaningful, and measurable. Data for each goal is graphed, with formal systems in place for review. Changes are made, as the need indicates, to treatment and instructional strategies. In addition to the collection and meaningful use of individual data, aggregated data for all individuals served is reviewed and used to drive organizational change, as applicable. Since this Goal Mastery initiative was implemented, Grafton has consistently exceeded its target goal rate of 80%.

How does Grafton monitor progress?

Multidisciplinary team meetings are held at least monthly to support and monitor each client’s education and treatment progress. Specific progress on goals and objectives in the plan of care (behavioral health) and the individualized education program (education) are discussed and reviewed. If progress is not on track, the team designs strategies and interventions to facilitate progress.

How does Grafton partner with the communities in which it resides?

Grafton collaborates not only with communities but also with families and other health care organizations to provide the best possible care and achieve demonstrable outcomes. We are a dedicated partner to the communities that we serve. For example, through a partnership with the state of Virginia, we work with the City of Winchester’s Department of Social Services to provide early intervention services for children aged birth to age three.

In addition, because we believe it is very important for individuals to develop natural connections within their communities, we work closely with local resources to integrate our services and facilitate social connections. In so doing, we are able to identify vocational learning opportunities as well as recreational and leisure activities for children and adolescents residing in Grafton’s specialized therapeutic group homes.

How does Grafton receive referrals?

referral form is located in the upper right corner of our website. Admission staff is available Monday thru Friday 8 a.m. to 6 p.m. by calling 888-955-5205. Voice mail is available for calls received outside of those hours. All calls are returned within 24 hours.

In addition, parents can go through their local school system, Department of Social Services office, and Community Service Boards or Community Service Agency. They can also be referred through their child’s physician or current hospital provider.

How are assessments made as to whether or not to accept an individual for admission at Grafton?

Grafton’s admission decision for each individual is based on materials and information gathered during a pre-placement interview. From these sources, we determine if we can support the level of care of the needs of the individual referred.

How does the admissions process work at Grafton?

Upon contacting our access center, you will be assigned an Admissions Case Manager who will assist you in determining what services best suits your needs. They will gather all necessary information to begin the admissions review process.

The admissions decision is made in two stages:

  1. The Admissions Department reviews referral materials and decides whether the applicant meets Grafton’s general criteria. Consideration is given to the person’s presenting problem(s), need for services, and legal eligibility criteria, when applicable. Program staff — specifically therapists, supervisors and administrators — may contribute to this decision. If the applicant does not meet the criteria, the sponsor is informed immediately, with the reason for the decision and suggested alternative placements.
  2. Once it is determined that the applicant meets the criteria, the sponsor is contacted regarding a mutually convenient date for a pre-placement interview. Typically, these interviews occur onsite, at one of Grafton’s facilities, providing the applicant family members, and agency representatives with an opportunity to tour the site and meet prospective team members. Should a visit to one of the sites not be possible, the interview can be completed at the applicant’s current location or, if necessary, by phone or via videoconferencing that meets all privacy standards.

Potential referrals are reviewed by a Grafton panel that includes a combination of clinical, medical, educational and residential personnel. Referral reviews occur within 24 hours of the interview in order to ensure a timely response with regard to an acceptance or denial. A decision to accept an individual is then forwarded to the Admissions Department to begin the intake process.

Are there situations in which Grafton will not accept an individual for services?

While we welcome and admit many individuals with complex co-occurring diagnosis and challenges, there are a few situations in which Grafton may refer an individual for treatment to a more appropriate facility. These include individuals who:

  • Have major medical problems requiring continuous medical oversight or treatment such as that provided in an acute care hospital (i.e.: 24-hour skilled nursing care, on site physician, technological monitoring)
  • Who are currently suicidal and are in imminent danger of harming themselves and, therefore, require an acute care inpatient level of care
  • Who are currently homicidal and are in imminent danger of harming others and, therefore, require an acute care inpatient level of care
  • Who require inpatient medical detoxification for drug or alcohol abuse

Grafton may determine individuals inappropriate for admission who:

  • Is in an acute psychotic condition
  • Is exhibiting behavior that endangers themselves or others
  • Has a history of setting fires
  • Has a highly contagious medical condition that in and of itself presents a clear danger to the individual or others (e.g. tuberculosis)
Can Grafton provide a rate sheet indicating what its service offerings cost?

We do have a rate sheet and are happy to share it. Our rates are also listed, in detail, on Virginia’s CSA website (Local Government à Service Fee Directory à Grafton). However, these rates are only one factor in determining the cost for a particular individual. Other considerations include the overall plan of care, how many hours of a particular type of therapy might be needed, etc. We are happy to talk to you on a case-by-case basis to determine what the cost might be for a particular individual.

It’s also important to bear in mind that these rates are Grafton’s standard fee for care, but contracts negotiated between the organization and the respective payer is a determining factor for final cost of care.



How are fees for Grafton’s group homes determined?

Grafton group homes are funded primarily through Early, Periodic, Screening and Diagnostic Treatment (EPSDT). The services are broken down into four main categories:

  1. Daily Supervision
  2. Case Management
  3. Supplemental Therapies
  4. Room and Board

EPSDT will fund everything except room and board costs. The exclusion of room and board is a federal regulation and can be found in the State Medicaid manual. EPSDT funds do not have a match on them.

Why are Medicaid rates for Grafton group homes higher than other group home providers in Virginia?

While the funds received from Medicaid are higher, the room and board charge for Grafton group homes is one of the lowest in the state of Virginia. Because staff to client ratios vary widely from organization to organization, costs — which are based on the required level of supervision — are similarly varied. We have outlined the minimum staffing ratio averages below, comparing these to Grafton’s:

Traditional Therapeutic Group Home (TGH):

1:4 during the day

1:8 at night

Cost = $146.2/day


1:2.5 during the day

1:4 at night

Cost = $357/day

Since Medicaid covers the $357 per day 99.9% of the time, what agencies are typically expected to pay out of pocket is the room and board, which is the cost most important to monitor.

How are costs for room and board differentiated from other costs for individuals living in group homes?

There are no state regulations around which costs should be included in each category. It is up to each provider to decide where to place expenses. Because it is done differently, the rates paid for room and board can vary significantly.

Provider Daily rate per client Monthly room & board for a 4 Person Home
Grafton $65.00 $7,800.00
Provider #1 $75.00 $9,000.00
Provider #2 $159.02 $19,082.40
Provider #3 $280.59 $33,670.80

Also, note that EPSDT funds do not have a match on them.



 How are Grafton services billed?

The tuition paid for educational services covers all materials and instructional services provided to the students. The funding agency (e.g. Medicaid, commercial insurance, agencies or parents) is billed at the end of each month. When other services (e.g. speech, occupational therapy, individual therapy, etc.) are warranted by the student’s individualized educational program plan, they will be billed, per the published rate schedule, to the funding agency/assigned payor.

Why are ABA services a separate cost? Why are they not integrated into the cost of an individuals’ program?

We do not include ABA in our education rate because that would create a situation where individuals who don’t need those services are still paying for it, but not using it.