The Grafton Experience

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• The Grafton Experience
• The Minimization of Restraint Initiative
• Melbourne, Australia
• November 2009

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GraftonAt a Glance

• Provides a continuum of services to children,
  adolescents and adults with co-occurring
  intellectual, developmental and psychiatric
  disabilities
• Operates three regional campuses
• Berryville Psychiatric Residential Treatment
  Facility
• Richmond and Winchester Community based group
  homes and special education programs
• Employs more than 600 dedicated staff
• Supports more than 400 clients per year
• Celebrates 50 years of best practice in
  behavioral healthcare
• Committed to excellence in the delivery of
  person-centered care and value-added services

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Service Locations
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Winchester Case Study

• Population served
• 83 children and 47 adults
• Autism or other pervasive intellectual
  disabilities
• May also have a concurrent psychiatric condition
• Lack safety awareness
• Behavioral symptoms require 24-hour residential
  support to ensure safety and effective treatment

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Restraint Usage Gains Attention

• SAMHSA issued a National Call to Action in 2003
  concerning restraint
• Growing body of research establishing that
  minimizing restraint results in
• risk of negative outcomes
• risk of staff injuries
• risk of client injuries

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NASMHPD Six Core Strategies

• Leadership Owns Organizational Change
  Initiative
• Using Data to Inform Practice
• Workforce Development
• Use of S/R Reduction Tools
• Consumer Roles in Inpatient Settings
• Debriefing Techniques

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Its Time for a Change

• New CEO brings new ideas and a call for action
• CEO issues mandate in summer of 2004
• Minimize the use of physical restraint and
  seclusion without increasing employee or client
  injuries.

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Methodology
Communication
Alternative Solutions
Leadership
Debriefing System
Therapeutic Treatment Planning
Training
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Leadership

• Clear Expectations
• Role Model
• Schedule of Support
• Physical presence of management
• Perseverance

Leadership
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Communication

• Designated Reporter on the Street
• Involved all employees in the process
• Stressed a trauma sensitive orientation

Communication
Leadership
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Training

• Utilized trauma sensitive orientation
• When supporting a client in a trauma sensitive
  environment employees consider the following
• Does this situation require a hands-on
  intervention?
• What choices and alternatives can I offer to this
  client?
• Who has a connection with the client?
• If I was experiencing emotional distress, how
  would I want someone to respond to me?

Communication
Leadership
Therapeutic Treatment Planning
Training
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Training

• Trained employees on Extraordinary Blocking
  techniques
• Introduced protective equipment to employees

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Therapeutic Treatment Planning

• Philosophy of Comfort vs. Control
• Analyzed and used data to drive treatment
  decisions
• Taught replacement behaviors and coping skills
• Teamwork with each member being equal

Therapeutic Treatment Planning
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Alternative Solutions

• Extraordinary Blocking techniques
• Protective Equipment
• Focus on employee and client safety
• Teams work to design proactive strategies
• When proactive strategies dont workdont lose
  the lesson

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Debriefing System

• Implemented system of immediate debriefing
• Used lessons learned with clients
  multidisciplinary team to make future treatment
  decisions
• Provided multiple levels of oversight

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Debriefing System
Initial Debriefing Questions

• What would you need next time to effectively use
  extraordinary blocking instead of restraint?
• Is there a plan in place for the client that
  offers alternative strategies to restraint?
• How can we avoid similar situations in the
  future?

• Was anyone hurt during the incident?
• How did you de-escalate the client?
• Was extraordinary blocking used?

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Lessons Learned

• Factors leading to program success
• Ensure buy-in from top level management and every
  employee
• Align incentive with three year key performance
  indicator (tied to incentive based pay program)
• Communicate plan to all employees
• Provide alternative treatment strategies/training
  to support clients and employees
• Collect and review progress made
• Sustain the new culture and know that the
  initiative never ends
• Quality cost less not more.

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Results

• 99.7 reduction in physical restraints
• 41.2 reduction in client-related employee
  injuries
• 94 reduction in
• Employee lost time
• Lost time/expenses from client-related employee
  injuries

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ResultsWinchester Facility
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ResultsWinchester Facility
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ResultsWinchester Facility
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ResultsOrganization-Wide
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ResultsOrganization-Wide
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ResultsOrganization-Wide
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Workers Compensation Premiums
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Workers Compensation Savings

• Estimated _at_ 3 Inflation 2006 1,434,278
• 1,434,278
• 1,434,278
• 1,434,278

• Estimated Grafton Savings
• 2006 163,568
• 154,023
• 192,576
• 285,613
• 795,780

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Organization-Wide Turnover
DSP Direct Support Professional
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Cost of Employee Turnover
Savings FY08 642,693 FY09 890,518 Total
1,533,211

• Assumptions
• Constant average DSP staff of 300 for all years
• Constant average DSP salary benefits, for all
  years (Grafton FY09 - 32,600)
• Cost of turnover 1/3 of salary plus benefits
  (10,867).
• Includes cost to hire, (recruiter salary, ads,
  background checks), training (trainer, materials,
  time in training/coverage), lost quality and
  efficiency while position is vacant

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Job Safety - "Safety on the job receives adequate
attention."
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Satisfaction On the Job I am satisfied with my
job.
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• Can We Afford to Do This?

Can We Afford NOT to Do This?
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ROI (thru 7/1/09) 3,916,922
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Demonstration of Value

• V Q C
• Enhanced quality of work environment
• Increased staff satisfaction retention
• Increased positive outcomes for clients
• Evidence-Based bottom line ROI

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• Questions?