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Friday, December 21, 2018

Grafton's Ukeru Technique a Game-Changer in Special Education

From The Winchester (Virginia) Star

By Brian Brehm
December 15, 2018

"Ukeru is the Japanese word for “receive.” The technique involves having a staff member use a cushion or pad for protection when an aggressive student acts out or becomes violent while instructors talk to the student in a calming manner."

Allyson Bateman Davis is the principal of Grafton School's
Bellview Avenue campus in Winchester.

WINCHESTER
— Four students were on stage this week practicing for the school’s annual holiday play, “Silent Night.”


Each was handed a white ukulele and shown some choreography for the song “I Want a Hippopotamus for Christmas.” After practicing twice, the boys started hitting their cues.

It’s not unusual to see something like this in a traditional school, but this is Grafton. What these boys did was amazing. All four have autism or intellectual disabilities that prevent them from attending public school. For them to process directions, learn a routine and perform as part of a group is nothing short of astounding.

Grafton has been facilitating these dramatic changes in special-needs children for 60 years. Its educational and training programs have earned national acclaim, and its patented Ukeru Systems method for handling behavioral problems without using physical force has been adopted by facilities in 25 states.

Despite its accomplishments, many people in the Winchester area don’t know what Grafton is or what it does, and those who have heard of it often characterize the school as a place where out-of-control kids have to be pinned to the ground or locked inside empty rooms until they calm down.

“We’re better known nationally, and to an extent internationally, than we are here in our own region,” said James Stewart, president and chief executive officer of the Winchester-based Grafton Integrated Health Network. “It’s hard to get over those old perceptions of who you were versus what you are today.”

Kelsey Woodley, a behavior specialist at the facility, works with a student.

Grafton is the largest residential provider of children’s services in Virginia. This year, it has provided early intervention, psychiatric residential treatment, therapeutic programs, applied behavior analysis and outpatient services to 3,258 individuals and families dealing with one or more developmental, intellectual or mental impairments.

Grafton has more than 800 employees and operates four schools and 35 group homes in Winchester, Berryville and Richmond; provides contracted services to 85 localities from Virginia to Maine; supports intervention and integration programs in the Northern Shenandoah Valley and Richmond; operates a youth shelter in Loudoun County; and partners with Winchester to offer the Infant and Toddler Connection of the Shenandoah Valley.

At the Ruth Birch Campus at 120 Bellview Avenue in Winchester, where the four boys were rehearsing for this month’s holiday play, students age 12 and up receive a classroom education and learn skills they can use in the workplace.

“Each classroom has its own area of specialization in the career world,” Principal Allyson Bateman Davis said.

Davis said the academics in each classroom focus on a specific line of work. The enterprise class deals with retail and food-industry skills like how to make change and earn a profit, the horticulture class provides information about landscaping and nurseries, and the clerical class shows students how to answer a phone, sort mail, file items and so on.

“Then we can start to really hone in on what that child might want to be doing as an adult once they leave school,” Davis said.

The majority of Grafton’s students live at home and attend classes during the day. Adults who need 24-hour supervision stay in one of its group homes, and children who need intensive care are housed in its psychiatric residential treatment facility in Clarke County.

Grafton students are referred to the organization by public schools that do not have the resources to educate and support them due to their significant emotional, intellectual or developmental impairments. Since state law mandates that all children must be properly educated, Virginia covers Grafton’s $262-per-day tuition, while Medicaid assists with residential expenses.

Grafton reported $58 million in revenues last year, with $21.4 million funneled by the nonprofit to its Winchester and Frederick County operations. More than 263 people in the Winchester area are full-time-equivalent employees of the organization.

Today’s Grafton is far removed from the private school system that once used state-approved techniques to physically restrain students who refused to follow instructions or had outbursts of anger or frustration. Where once thousands of restraints were performed each year — 3,829 in 2004 alone — now there are less than 10.

Concurrently, more students are showing greater educational and behavioral progress, with student goal achievements increasing from 35 percent in 2006 to 80 percent today. Grafton Chief Operating Officer J. Scott Zeiter said that’s no coincidence, and he wonders why anyone ever expected benefits from a system enforced by physical intervention.

The turnaround in thinking began in the early 2000s when Grafton employee Kimberly Sanders was assisting a girl who needed help disrobing for a shower. Sanders discovered the girl had a large burn from a hot iron on her leg, evidence of severe abuse by a father who had become frustrated with her behavior.

“Kim said, ‘If this young lady isn’t going to change her behavior by her father burning her with an iron, then the aggressive nature of how we do behavior modification isn’t going to change it either. We’ve got to do something different,’” Stewart said. “That was the genesis.”

Many of Grafton’s students have had prior abuse or don’t know how to deal with the frustrations of being disabled. Administrators came to realize these emotional traumas were on par with post-traumatic stress disorders experienced by war veterans.

“When you buy that they’re neurologically pre-wired to be reactive, then your whole job starts to change into being a diffuser,” Zeiter said. “You need to realize someone is pre-set to be this way and you need to change the environment and the way you interact to not bring on that crisis.”

This was an 180-degree change from the previous belief that students needed to do as instructed or face consequences. By following the old practice, Zeiter said, “we were bringing on the very crisis we were trying to treat.”

The revised approach came too late for 13-year-old Garrett Halsey, an autistic and intellectually challenged Grafton group home resident who died on December 23, 2004, while being restrained by six staff members. Garrett’s family filed a wrongful-death lawsuit and reached a $1.5 million settlement with the school in 2010.

While Grafton maintained it did nothing wrong and said the incident did not change the way it cared for students, the school issued a mandate in 2005 to eliminate physical restraint in a manner that would not jeopardize staff or students. Teachers, specialists and administrators worked cooperatively to develop a hands-off approach to crisis management that emphasized comforting students rather than controlling their outbursts.

The organization also stopped using seclusion as a means of getting unruly children to calm down. All the doors were removed from the bare rooms in Grafton facilities where students were once locked inside until a trained staff member decided he or she was calm enough to come out.

Stewart, who was named CEO of Grafton in 2016, said the new response method resulted in a 99 percent drop in physical restraints and saved an estimated $16 million in staff injury and turnover expenses over 11 years.

“Our workers’ compensation claims were very high because of injuries to staff during restraints,” Stewart said. “Our workers’ compensation costs went from about $2.4 million in 2007 down to under a million dollars every year.”

The results were so positive that Grafton decided in 2015 to market its patented, trademarked crisis-management technique to other agencies. It named Sanders president of Ukeru Systems and licensed the method to approximately 115 private day and residential programs, private and public schools, psychiatric hospitals and forensic units.

Ukeru is the Japanese word for “receive.” The technique involves having a staff member use a cushion or pad for protection when an aggressive student acts out or becomes violent while instructors talk to the student in a calming manner.

The key is understanding that a person traumatized by autism or a similar impairment does not process surroundings and circumstances as others do, so they can be triggered by seemingly innocuous occurrences. Stewart used the example of a girl at the Berryville facility who would act out at bedtime every night.

“We came to find out she had been sexually abused by her father, and closing the door was a trigger for her trauma-response behavior,” he said.

While physical restraint could have curbed each disruption as it arose, Stewart said Ukeru dictated that staff address the root cause of her behavior so they could teach the girl how to move beyond her trauma.

Everything Grafton does is geared toward preparing students to be as independent and productive as possible.

Many of its success stories will assemble on stage for this month’s holiday play. Davis said parents in the audience will see their children performing, dancing, smiling and interacting — things they may have never dreamed possible before their sons and daughters came to Grafton.

“That’s when the tears really start to pour,” Zeiter said.

For more information on Grafton Integrated Health Network and Ukeru Systems, visit grafton.org and ukerusystems.com.

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