Vol 1 • Issue 1 • Sep 2009

Welcome to the inaugural edition of Grafton’s online e-newsletter, Continuums. The theme of this issue is “change.” I don’t think there is a word that more aptly defines the current period in our industry. Collectively, we are in the midst of a time of intense transition as we explore a changing model of service delivery. History has taught us that the best way to serve our clients is through one umbrella System of Care. The state has continued to transform services provided to children, youth and families by creating partnerships and developing community-based support systems.

Even before the term “System of Care” became common nomenclature, it was the modus operandi for Grafton. Throughout our 50 years of experience, we have always sought to bring together the strongest team – with individuals, families, communities, and other agencies playing an active part – to ensure the client receives the most appropriate and least restrictive care options. This approach leads us to partner with localities to better meet the needs of clients in their home communities. A great example is our Richmond campus which just celebrated its 20th anniversary.

Richmond initially served just four clients; today, it serves 75. As the needs of the community changed, so did the services Grafton provides. Over time, the organization’s support in this community expanded to include a school and community group homes for adults. We are proud of the work we’ve done in Richmond – as well as Berryville and Winchester. We look forward to many more years of strategic partnership across the state, identifying areas of need and providing a continuum of services to deliver positive outcomes.

At the Richmond campus and across all of Grafton’s facilities, each plan of care is as unique as those it serves. Yet one thing remains constant: making decisions based on evidenced-based best practices. Thoughtful analysis of each case is used to create an optimal environment for clients. As we continue to evolve our System of Care, creating that optimal environment requires further integration and outreach beyond our own walls. We will continue to involve the family in treatment planning from the earliest possible point; provide access to resources within the community and link them back to the client’s interests and strengths; and increase the client’s functional autonomy through things like vocational training and real-world work experience.

We are very excited about sharing some of our current work with you through this newsletter. One of the most important aspects of Continuums, though, is the opportunity to hear from you. It has been conceived as a tool for you, so please let us know if you find it helpful. In the meantime, I hope you enjoy some of the highlights shared in this issue.

Success Story

ASSESSMENT:
Prior to arriving at Grafton in 2005, Cindy* had a long history of maladaptive behaviors including severe physical aggression toward others, jumping out of moving vehicles, running away, delusional thinking that interfered with her functioning, self-injurious behavior, and property destruction. She had participated in a variety of outpatient mental health services and had numerous psychiatric hospitalizations.

Upon enrollment at Grafton’s Richmond facility, a multidisciplinary team (MDT) evaluated Cindy across several different layers, each one critical to a successful outcome. This evaluation included functional behavior, academic, medical and residential living assessments.

DIAGNOSIS:
Cindy’s disorder included confused thinking, hallucinations and delusion as well as impulse control deficits marked by an inability to delay gratification. She was also medically frail and suffered from a blood disorder that caused her to bruise very easily and exposed her to a risk of internal bleeding. This symptom profile is distinct, yet represents Grafton’s niche expertise in the care and treatment of co-occurring disabilities.

Even after coming to the Richmond campus, Cindy continued to experience delusions and hallucinations as well as unpredictable rages. She bolted regularly and took no pride in her appearance. Over time, the frequency and severity of her unsafe behaviors increased to a level where she could no longer remain in a community-based program.

With Cindy continuing to deteriorate, the Richmond team reached out to colleagues at Grafton’s Psychiatric Residential Treatment Facility (PRTF). Collectively, they agreed that transferring Cindy to the Berryville PRTF would best support her progress and help her to, ultimately, live a fuller life.

THERAPEUTIC INTERVENTIONS:
MDT members from both campuses collaborated on Cindy’s treatment, ensuring that her strengths, needs, abilities and preferences were incorporated into her individualized plan of care through a careful, titrated psychiatric regimen, cognitive behavioral treatments and modifications to her environment. Cindy began to rapidly progress.

For instance, she is very perseverant about aspects of her appearance. In the past, she has insisted that she is a race different from her own and that she is pregnant when she is not. To help manage these delusions, the staff does not engage in these discussions with Cindy allowing her to entertain this type of thinking only within the confines of her own bedroom. To help her address anxiety resulting from challenges to her thinking, she participates in cognitive behavioral psychotherapy sessions.

Incentives were used to manage Cindy’s behavior. For instance, money is a strong motivator. At Berryville, she participated in a level-system called “Step-It-Up” where clients use credit-cards to manage a “bank” account. This program enabled her to earn a weekly allowance to positively reinforce days she behaved without incident. Today, she continues to earn points for positive behavior and uses credits to purchase items at the school store.

Through the benefit of intensive individual therapy, medication management and behavioral intervention, Cindy restored functional autonomy and succeeding in moving to a less restrictive level of care. The Berryville and Richmond teams worked closely together to facilitate her transition back to a group home and prepared the environment to her specifications to make her as comfortable and feel as at home as possible.

One of the most important contributors to Cindy’s outcome was the close coordination among her MDT. The transfer to and from Berryville was handled seamlessly as a result of the due diligence of the team and their ongoing communication. The entire group is able to identify the “hot” issues for Cindy on any given day and collectively respond to them. Because of her physical frailty, having an on-site medical team at both facilities was also extremely beneficial.

PROGRESS:
Cindy continues to thrive through the use of a reinforcement program. She enjoys her experiences in the community and is learning the skills she needs to increase her functional autonomy. She continues to build her relationships with others, including her older sister.

She has learned vocational skills, as well. After projects assembling pizza boxes and collating information for the Red Cross, she is looking forward to a new job working onsite at a local Domino’s Pizza. At a recent Individualized Education Plan (IEP) meeting, Cindy was able to actively advocate on her own behalf.

She has made tremendous progress in developing coping skills. Now, when she gets upset, she turns to her behavioral therapist, other staff, peers and family to talk through her frustration. Since she returned to Richmond, she has had significantly fewer serious behavioral incidents.

In addition to learning to drive she would like, one day, to live in an apartment with her sister. Her success in returning to Richmond has given her a positive foundation to continue to thrive.

*Client’s name has been changed to protect her privacy

• In July, Grafton celebrated the 20th anniversary of its Richmond facility. In response to community needs, Grafton’s Richmond region opened its doors In July 1989. Originally, the facility supported four young men with disabilities. 20 years later, Grafton’s Richmond Facility now supports more than 70 clients and has over 130 employees in ten community-based group homes.
• All of Grafton’s school sites were recently granted a five year accreditation and commendations by the Virginia Association of Independent Specialized Education Facilities (VAISEF).
• Kim Sanders, executive director of Grafton’s Winchester region, recently participated as a speaker at the International Association for the Scientific Study of Intellectual Disabilities’ (IASSID) Asia Pacific Regional Conference in Singapore. In response to the growing amount of support in the field, Sanders was asked to present on Grafton’s Minimization of Restraint initiative.
• Allyson Bateman, education administrator, presented a poster session entitled “Increasing Quality of Goal Mastery Through Data-Based Decision Making” at the 2009 Council for Exceptional Children (CEC) Convention in Seattle, Washington April 1-4. CEC is the largest international professional organization dedicated to improving the educational success of individuals with disabilities and/or gifts and talents.
• Lynette Johnson, director of education, and Lisa Marshall, clinical administrator presented a session on “Increasing the Quality of Goal Mastery through Data Based Decision Making: One School’s Journey from Too Much of the Wrong Kind of Data to the Just Right Amount of Effective Data” at the Virginia Association of Specialized Education Facilities (VAISEF) for its spring conference.
• Leah Robinson, training & development director participated in a VAISEF panel discussion on “Employee Development and Retention Tools for Direct Support Professional Employees” in April 2009.
• Shamsi Sadeghzadeh, clinical administrator presented a session on “Understanding Autism and Managing Challenging Behaviors” at an informational seminar for parents, teachers, and professionals sponsored by WVPT—Virginia’s public television, the Virginia Cooperative Extension and James Madison University in September 2009.

• Dana Papke, Chief Operating Officer and Leah Robinson will present “Employee Development and Retention Tools for Direct Support Professionals” at the American Association of Children’s Residential Centers’ (AACRC) 53rd annual conference in October 2009.
• Jim Gaynor, Grafton CEO/President and Kim Sanders will participate in a panel discussion at the AACRC conference on “Creating and Maintaining the Restraint Free Milieu—Best Practices” in October 2009.
• Jim Gaynor, Grafton CEO/President and Kim Sanders will present a workshop on “The Journey Towards Promoting Dignity Through Safe Elimination of Physical Restraints,” sponsored by The Office of the Senior Practitioner and National Disability Service in Victoria, Australia in November 2009.
• Kim Sanders will present at the 9th annual Australasian Society for the Study of Intellectual Disability on The Minimization of Restraint Initiative in November 2009.

Feedback

We want to hear from you! Do you have something you want to tell us? Is there anything else you’d like to know about Grafton? Please share your thoughts by sending an email to communications@grafton.org.