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A seven year old handcuffed during his after school program in Flint, Michigan.
A South Carolina high school student forcibly yanked from her chair and restrained in her classroom.
Children with Autism confined and sprayed with water in Maryland.
We may be seeing more of these incidents due to the Internet and the proliferation of cell phones, but they are not new. Using physical restraints — along with the practice of seclusion — should, however, become a thing of the past.
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Welcome to the inaugural issue of It Starts with You, a newsletter published by Ukeru Systems and intended to help spread a message of comfort versus control.
At Ukeru Systems, we often travel the country (actually, the world) training others on restraint and seclusion free techniques. Because of this, we have a unique vantage point and opportunity to strengthen collaboration and information sharing. With that in mind, we are launching this quarterly newsletter as a way to open up an important channel of communication. Because we believe that, together with partners like you, we can create a safer, more person-centered environment for addressing aggressive behavior in a variety of settings.
In the following articles, you’ll read about Grafton Integrated Health Network’s — the parent organization of Ukeru Systems — road to minimizing restraint as well as the experience of Mark Gleason, Chief Operating Officer of Northwestern Community Services, and a 30 year behavioral health care veteran. As someone who started his career on a locked psych ward, Mark knows a thing or two about using restraints and seclusion. Importantly, he is also a staunch advocate for creating a restraint free environment.
We also want to keep you informed of what Ukeru is doing and where we will be next. To that end, we are including information on some recent highlights and upcoming speaking engagements.
To stay informed in between issues of this newsletter, please be sure to follow us on Twitter @UkeruSystems or on Facebook. Current information is also available on our our website. We hope you find this newsletter helpful and look forward to hearing your feedback!
Sincerely,
Kim Sanders, President, Ukeru Systems
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In 2015, Grafton Integrated Health Network — an organization serving children and adults with autism and co-occurring psychiatric diagnoses — launched Ukeru Systems, a safe, comforting and restraint-free crisis management program developed by and for behavioral health professionals and paraprofessionals, educators and parents.
It is the first crisis training program to completely eliminate the use of restraints and seclusion as accepted behavioral management tools. Ukeru (Japanese for “to receive”) is about engaging, sensing, feeling and responding to what someone is trying to communicate through his or her actions while also maintaining the safety of everyone involved.
How do we know this works? We’ve done the work in our own environment and seen the rewards. A decade ago, Grafton issued a mandate to eliminate restraints without compromising employee or client safety. Since then, it has reduced the use of restraints by more than 99 percent. It also significantly reduced the number of injuries to both clients and those who care for them and reduced costs associated with workers’ compensation policies and employee turnover, saving an estimated $15 million over ten years. Grafton’s experience makes clear that restraint and seclusion can be eliminated without compromising safety as long as employees are properly trained.
Today, Ukeru leadership travels the country training others on these techniques. If you are interested in learning more or having a Ukeru trainer come to your organization, please visit our website.
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For several decades, policymakers, clinicians, teachers, school principals, and direct care providers in child-serving systems have been challenged to reduce the use of seclusion and restraint, especially in residential and school settings. In a recent video produced by Georgetown University’s National Technical Assistance Center for Children’s Mental Health and JBS International, Ukeru President, Kim Sanders, highlights the importance of avoiding restrictive procedures whenever possible.
The video also illustrates how some providers have changed their practices; implemented creative methods to keep staff and youth safe without re-traumatizing them; and, in the process, reduced staff turnover, staff and youth injuries, and costs.
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Ukeru President, Kim Sanders, and Training and Performance Architect, Chris Feltner talk about minimizing restraints and seclusions on OZY.
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On November 10, Ukeru was a featured panelist, along with Karyn Harvey from ARC Baltimore, in Georgetown University’s National Technical Assistance Center for Children’s Mental Health webinar on safety without seclusion and restraint.
In addition, this fall Ukeru had the pleasure of attending and presented at several conferences including:
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In early 2016, Ukeru will be hosting a series of training events — including a one day User Certification and a two day Train-the-Trainer certification course — at its Winchester, VA campus.
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January 5-6
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February 9-10
- March 8-9
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During the sessions:
- Conceptual training will be provided on:
- Verbal and nonverbal communication;
- Managing and de-escalating conflict by converting/diverting aggressive behavior;
- Building an environment focused on comfort rather than on control;
- Taking into account the high prevalence of traumatic experiences in individuals who receive services for developmental, behavioral and mental health needs.
- Physical techniques will also be taught by including the effective use of protective equipment to keep both the caregiver and client safe.
For more information or to register, please contact info@ukerusystems.com.
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On December 17 at 1:00 - 2:30 PM EST, Ukeru will participate in the second of a two-part webinar series hosted by the National Technical Assistance Center for Children and Mental Health. This second webinar will focus on workforce development across school-based, community-based and residential settings.
To register, click here.
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Mark Gleason, Chief Operating Officer, Northwestern Community Services
As part of our efforts to share information and help support a vision of eliminating restraints and seclusions, we want to shine a spotlight on individuals and organizations making strides toward a trauma informed, person centered environment. Mark Gleason, Chief Operating Officer of Northwestern Community Services, exemplifies this spirit and, as a nearly 30 year veteran in behavioral healthcare, has ample experience from which to draw.
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Q: To start, what is your background?
A: I began my career working in locked psych wards with children. I’ve also worked in residential care, inpatient and outpatient environments. I’ve worked with both children and adolescents and, now, with adults.
Q: Northwestern uses the Ukeru training approach. What has your experience been?
A: I’ve been an instructor in other systems for a long time and I’ve seen a lot of different systems. After going to Grafton to observe the Ukeru training — which can be seen online as well — I was able to look at it in informed way. It was clearly just better; more dignified, more respectful and better able to adapt in different environments.
Ukeru is very personal. A lot of other systems have been around a while and they are clearly businesses. With Ukeru, there is a different level of accessibility and discussion. For trainers, it’s very interactive. Even after the training, Ukeru is very helpful in terms of responding to ongoing questions. It is a true partner in helping to create and maintain a restraint free environment.
The feedback on the training is that it’s actually fun. Don’t get me wrong; it’s hard work. But we find the employees embrace it. Because they enjoy it, we get much more buy in and retention.
Q: How does this compare to your experience with other trainings?
A: Northwestern is a large organization with many different kinds of programs – from residential to outpatient, spanning all ages. What I noticed with other training programs is that they had no flexibility or ability to adapt to different populations with different needs. It was a cookie cutter approach. They also spent a lot of time on “control” techniques.
Q: Having worked in many acute settings and with clients in crisis, what is your view on the use of restraints and seclusions?
A: To be honest, I’ve struggled with restraints and seclusions. I’ve been in the field since 1986 and have seen many changes over that time. It used to be very control oriented and restraint-based. I remember the first place I interviewed used “wet sheet” treatment. When I reflect on that, I think, “Wow, we’ve come a long way.”
Q: What would you say to those who think retraints and seclusions are necessary; that, without them, we invite greater risk?
A: Some might argue that restraints are necessary in certain environments. But I’ve worked in many different environments, including in locked psych wards. Even with that experience in mind, I don’t believe restraints are the answer. Maybe there is an environment for it; but I don't personally believe that anymore.
In addition, our greatest asset is our people and staff injuries were an issue. Restraints have a high profile of injuries. I know that because I used to do it; I still have bite mark scars on my hands. By transitioning to a restraint-free environment, Northwestern’s staff injury profile has gone down.
Q: How does a restraint free approach benefit:
The individual in distress?
Clients can often sense when someone is about to restrain them. They start defending themselves. When staff has an approach that is very client-centered, looking at it from a comfort perspective, the clients don’t feel the need to defend themselves. By just alleviating that anxiety for the client, by moving to “comfort” versus “control,” individuals don’t gear themselves up for a crisis. If they understand that they won’t be physically controlled, it allows for a more therapeutic approach.
The caregiver?
When staff realizes that the organization is not expecting them to use restraints, it’s actually a huge relief to them. They are able to think more about the therapeutic needs.
Others who are present?
In a classroom situation, for example, you have to consider: what is the message you are sending students if a teacher tries to physically control their peer? First of all, the teacher is now ignoring all but one individual in the classroom; the focus narrows down to one single student. It also creates an environment that is very unpredictable.
In contrast, if you establish an environment that is very person centered, the classroom becomes a place where each student has a sense of comfort and calm.
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