As president of Ukeru Systems®, a Winchester, Virginia-based organization, I appreciate the opportunity to share our views as you consider 8VAC20-750. My organization, along with our parent company, Grafton Integrated Health Network, commends the Virginia Department of Education for working to ensure that its policies on restraint and seclusion are in the best interest of all students in the state. Ukeru is the only crisis training program in the country that provides trauma-informed, physical alternatives to restraint and seclusion. We work with over 140 organizations – including public schools and school districts - across North America and in the state of Virginia to give teachers and staff the tools they need to eliminate the need for these dangerous practices.

Like the Virginia Department of Education, Ukeru is working towards the goal of ensuring maximum classroom safety for both students and teachers, while creating a productive and positive learning environment. Based upon our 60 years of experience, and as a nationally recognized leader in the minimization of restraint[1][2][3][4], we strongly believe that restraint and seclusion are not only dangerous to the students in the state of Virginia and across the country, but that they are also unproductive. Neither is an evidence-based practice, nor is there data to suggest that they lead to reduced violent or uncontrolled behavior.[5] In fact, research has shown that these outdated, coercive behavior techniques can cause, reinforce, and maintain aggression and violence in the classroom rather than defuse it.[6]

Ukeru celebrated the Virginia legislature in 2015 for passing a law directing the Virginia Board of Education to adopt regulations governing the use of restraint and seclusion. We generally support these regulations as published by the Governor’s office earlier this year. However, we ask that you please consider several factors:

• Prone Restraints, or a face down physical restraints, should be banned within the regulations. This technique is especially dangerous, having led to several deaths of adults and children. An investigation by Disability Rights California found a number of deaths or serious injuries sustained while the victim was restrained face down or prone.[7] The medical expert in this investigation concluded that these deaths or injuries were most likely caused by positional asphyxiation and, specifically, the prone restraint position. According to the report, the mechanism of death is a sudden fatal cardiac arrhythmia or respiratory arrest due to a combination of factors causing decreased oxygen delivery at a time of increased oxygen demand. 

This is only one of many reports that look at the dangers of prone restraint. One need only look at the headlines to find multiple examples of a prone restraint gone terribly wrong. This technique has proven so dangerous that 27 states have banned it generally and 33 have banned it specifically for children with disabilities and those in a special education setting.[8] We urge Virginia to follow suit - prone restraint is not a necessary tool for educators and its use in classrooms in Virginia is outdated and unsafe.

• Trauma plays a large role in understanding the inefficiency of restraint and seclusion. For individuals who have experienced traumatic events, the impact of re-experiencing that trauma through the use of restraints and seclusions can be devastating. Studies estimate that nearly 50% of U.S. children have experienced at least one potentially traumatic "adverse childhood experience," or ACE.[9]  Children who have experienced trauma may act out in negative ways when placed in stressful or “trigger” situations.

Given the prevalence of trauma, Ukeru believes that all intervention - educational and behavioral - should emanate from a foundation of comfort versus control. Teaching from a trauma-informed platform can shift the perspective from “What’s wrong with this child?” to “What’s happened to this child to make him/her express this behavior?” which is far more effective.

• In order to reduce the number of restraint and seclusion incidents, training is key. Educators must be given the proper tools to deescalate conflicts and manage behavioral issues in a way that is safe for both the student and themselves. After all, no one wants to restrain or seclude a child, they simply don’t know what else to do. With training on key concepts — not just trauma-informed care but also conflict resolution, among others — as well as the physical techniques and tools that help manage challenging behavior, educators will have meaningful alternatives to restraint and seclusion from which to draw.

Currently, the regulations state that restraint “may only be used in an emergency situation.” However, what constitutes an emergency for one teacher may not for another. We need to ensure that all teachers are trained equally and given the necessary education to avoid immediately moving from verbal de-escalation to restraint. Rather than instructing teachers how to restrain, we should be instructing how NOT to restrain while still keeping themselves and their students safe.

Ukeru was created with these factors in mind. Many years ago, Grafton Integrated Health Network used restraint with regularity when a consumer presented behaviors that were perceived as dangerous. In 2004, the organization embarked on a concerted effort to reduce the use of restraint and seclusion. This effort resulted in:

• A 99% decrease in restraint frequency
• A 100% reduction seclusion
• A 97% decrease in staff injury due to restraint
• A 64% decrease in client-induced staff injury
• A 133% increase in client goal mastery from 2003 to 2016
• A savings of over $16 million in lost time expenses, turnover costs, and workers’ compensation policy costs.

Based upon these learnings and results, the Ukeru model was launched. We are honored to have received national and international recognition for these efforts, including winning the prestigious Negley President’s Award for Excellence in Risk Management twice (2008 and 2012); the 2013 National Council Impact Awards; and recognition by the Substance Abuse Mental Health Services Administration for clinical best practices in restraint and seclusion reduction (2010). In addition, data resulting from our efforts have been published in the journal Advances in Neurodevelopmental Disorders.

Examples like Grafton’s make clear that restraint and seclusion can be eliminated without compromising safety. Further, we know that these results are not an anomaly. They can and have been replicated elsewhere, with appropriate training. Ukeru has trained over 140 organizations - including many schools and school districts – in 28 states. We are currently working with the Loudoun County Schools in Virginia. The results have been impressive, proving that others can achieve outcomes similar to our own.

We are grateful that the Virginia Department of Education is evaluating the use of restraint and seclusion in classrooms. We know that greatly reducing or even eliminating restraints is not only possible, it is the environment in which we successfully operate. We feel sure that, by taking the appropriate steps, schools throughout the state can have a similarly successful experience.

[1] Grafton was awarded The Negley Presidents’ Award for excellence in risk management practices.

[2] Grafton has received the National Council Excellence in Behavioral Healthcare Award.

[3] Grafton has been recognized by SAMHSA for its clinical best practices.

[4] Grafton is one of only four North American providers recognized by the International Initiative Mental Health Leadership as exemplifying best practices in treatment of individuals with complex disabilities

[5] Promoting Alternatives to the Use of Seclusion and Restraint – Issue Brief #4. SAMHSA, 2010

[6] IBID

[7] The Lethal Hazard Of Prone Restraint: Positional Asphyxiation. Disability Rights California. 2002.

[8] How Safe is Your Schoolhouse: An Analysis of State Seclusion and Restraint Laws and Policies. Jessica Butler. 2017

[9] The Adverse Childhood Experiences (ACE) Study. Centers for Disease Control. 1998